Provider Demographics
NPI:1073179990
Name:FIVE STAR HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:FIVE STAR HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-454-5089
Mailing Address - Street 1:10203 WHISPERING PINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7154
Mailing Address - Country:US
Mailing Address - Phone:501-454-5089
Mailing Address - Fax:
Practice Address - Street 1:3824 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2037
Practice Address - Country:US
Practice Address - Phone:501-454-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251E00000XAgenciesHome Health