Provider Demographics
NPI:1093798373
Name:FIVE STAR QUALITY CARE-KS, LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE-KS, LLC
Other - Org Name:BRANDON WOODS AT ALVAMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:1501 INVERNESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1870
Mailing Address - Country:US
Mailing Address - Phone:785-838-8000
Mailing Address - Fax:785-838-8001
Practice Address - Street 1:1501 INVERNESS DRIVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1870
Practice Address - Country:US
Practice Address - Phone:785-838-8000
Practice Address - Fax:785-838-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN023009310400000X, 311500000X, 314000000X
310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200629080AMedicaid
175277Medicare Oscar/Certification