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General NPI Number Information
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NPI Number | 1760400261
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Entity Type | Organization
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Legal Business Name | FIVE STAR MEMORIAL WOODS LLC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 777 N POST OAK RD
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City | HOUSTON
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State | TX
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Zip | 77024-3800
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Country | US
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Telephone | 713-956-0732
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Fax | 713-956-0732
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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 | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | KATHERINE E POTTER
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 113230
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 100820
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 129232
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License Number State | TX
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