MEDICARE: 5-STAR COMMUNITY LIVING 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	385H00000X	Respite Care
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942198502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5-STAR COMMUNITY LIVING LLC

Provider Business Mailing Address
First Line	:	8000 HATHAWAY LN
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-6699
Country	:	US
Telephone Number	:	254-317-0569
Fax Number	:	254-213-2336

Provider Business Practice Location Address
First Line	:	523 CATTAIL CIR
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2655
Country	:	US
Telephone Number	:	254-317-0569
Fax Number	:	254-213-2336

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	DR. SHARON RENE CRUMBLIN
Credential	:	DBA, LMSW
Telephone Number	:	254-317-0569

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/30/2025

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