Provider Demographics
NPI:1174662613
Name:FIVE STAR QUALITY CARE CT
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE CT
Other - Org Name:ORTHOPEDIC REHABILITATION SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8214
Mailing Address - Street 1:400 CENTRE ST
Mailing Address - Street 2:ATTN NANCY CLARK
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2094
Mailing Address - Country:US
Mailing Address - Phone:617-219-1404
Mailing Address - Fax:617-796-8243
Practice Address - Street 1:250 POND ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5351
Practice Address - Country:US
Practice Address - Phone:800-333-2561
Practice Address - Fax:781-356-4222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE CT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5897300001Medicare NSC