Provider Demographics
NPI:1114929684
Name:FIVE STAR QUALITY CARE-NE, LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE-NE, LLC
Other - Org Name:CENTENNIAL PARK RETIREMENT VILLAGE
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 1:400 CENTRE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2094
Mailing Address - Country:US
Mailing Address - Phone:617-796-8387
Mailing Address - Fax:617-796-8375
Practice Address - Street 1:510 CENTENNIAL CIRCLE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6586
Practice Address - Country:US
Practice Address - Phone:308-534-7000
Practice Address - Fax:308-534-8216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE-NE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47-0704192/11310400000X
310400000X, 314000000X
NE47-0704192/00314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0704192/11Medicaid
NE47-0704192/00Medicaid
NE47-0704192/11Medicaid
NE47-0704192/00Medicaid