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NPI Code Detail

MEDICARE: FIVE STAR QUALITY CARE-COLORADO LLC

MEDICARE: FIVE STAR QUALITY CARE-COLORADO 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
1314000000XSkilled Nursing Facility1091CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255386546
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIVE STAR QUALITY CARE-COLORADO 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 : 617-796-8375
Provider Business Practice Location Address
First Line : 515 FAIRVIEW AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-2863
Country : US
Telephone Number : 719-275-0665
Fax Number : 719-275-6225
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : KATERINE E POTTER
Credential :
Telephone Number : 617-796-8387
Provider Enumeration Date : 05/24/2006
Last Update Date : 03/26/2019

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Directions to “FIVE STAR QUALITY CARE-COLORADO LLC ” Practice Location

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