Provider Demographics
NPI:1003545146
Name:FIVE STAR QUALITY CARE-IN LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE-IN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. V.P., CFO, TREASURER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:4519 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4241
Mailing Address - Country:US
Mailing Address - Phone:317-849-2244
Mailing Address - Fax:317-849-6625
Practice Address - Street 1:4519 E 82ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4241
Practice Address - Country:US
Practice Address - Phone:317-849-2244
Practice Address - Fax:317-849-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility