MEDICARE: FIVE STAR QUALITY CARE-NE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	ALF050	NE

General Provider Information

NPI Number	:	1013963412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR QUALITY CARE-NE, LLC

Provider Business Mailing Address
First Line	:	400 CENTRE ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-2094
Country	:	US
Telephone Number	:	617-796-8387
Fax Number	:	617-796-8385

Provider Business Practice Location Address
First Line	:	3030 S 80TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3254
Country	:	US
Telephone Number	:	402-391-8566
Fax Number	:	402-391-1033

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	KATHERINE E POTTER
Credential	:
Telephone Number	:	617-796-8387

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/26/2019

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