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NPI Code Detail

MEDICARE: FIVE STAR QUALITY CARE FL LLC

MEDICARE: FIVE STAR QUALITY CARE FL 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 Facility15550962FL

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 : 1760591358
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIVE STAR QUALITY CARE FL LLC
Provider Business Mailing Address
First Line : 2701 NORTH COURSE DRIVE
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-3089
Country : US
Telephone Number : 954-975-8900
Fax Number : 954-975-8933
Provider Business Practice Location Address
First Line : 2701 NORTH COURSE DRIVE
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-3058
Country : US
Telephone Number : 954-975-8900
Fax Number : 954-975-8933
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : KATHERINE E POTTER JR.
Credential :
Telephone Number : 617-796-8387
Provider Enumeration Date : 08/29/2006
Last Update Date : 05/04/2021

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Directions to “FIVE STAR QUALITY CARE FL LLC ” Practice Location

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