MEDICARE: 5 STAR ADULT DAY CENTER INC

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	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1598335416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR ADULT DAY CENTER INC

Provider Business Mailing Address
First Line	:	2966 WHITE BEAR AVE N
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1318
Country	:	US
Telephone Number	:	651-788-7238
Fax Number	:	651-756-8553

Provider Business Practice Location Address
First Line	:	2966 WHITE BEAR AVE N
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1318
Country	:	US
Telephone Number	:	651-788-7238
Fax Number	:	651-756-8553

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PAUL MICHAEL THAO
Credential	:
Telephone Number	:	651-788-7238

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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