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General NPI Number Information
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NPI Number | 1386690311
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Entity Type | Organization
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Legal Business Name | FIVE STAR QUALITY CARE MO LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1317 N 36TH ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2359
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Country | US
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Telephone | 816-676-1630
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Fax | 816-232-5862
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Provider Business Mailing Address
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Address Line | 400 CENTRE ST
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City | NEWTON
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State | MA
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Zip | 02458-2094
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Country | US
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Telephone | 617-796-8387
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Fax | 617-796-8375
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Authorized Official
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Title or Position | CEO
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Name | BRUCE J MACKEY JR.
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Credential |
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Telephone | 617-796-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 031982
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License Number State | MT
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