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General NPI Number Information
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NPI Number | 1124596606
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Entity Type | Organization
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Legal Business Name | FIVE-STAR INTEGRATED HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 1125 WEST ST
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3607
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Country | US
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Telephone | 667-204-0614
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 WEST ST
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3607
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Country | US
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Telephone | 667-204-0614
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TAMIA D ROLLINS-MUSGRAVE
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Credential |
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Telephone | 443-534-3652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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