MEDICARE: FIVE STAR OVERLAND PARK 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	N046033	KS
2	314000000X	Skilled Nursing Facility	N046033	KS

General Provider Information

NPI Number	:	1154376515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR OVERLAND PARK LLC

Provider Business Mailing Address
First Line	:	400 CENTRE ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458
Country	:	US
Telephone Number	:	617-796-8387
Fax Number	:	617-796-8375

Provider Business Practice Location Address
First Line	:	3501 WEST 95TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66206-2063
Country	:	US
Telephone Number	:	913-648-4500
Fax Number	:	913-648-6144

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/28/2019

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