Provider Demographics
NPI:1467186932
Name:FIVE STAR ADULT CARE CENTER
Entity Type:Organization
Organization Name:FIVE STAR ADULT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SASON
Authorized Official - Middle Name:HAIMOV
Authorized Official - Last Name:FUZAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-209-8282
Mailing Address - Street 1:3420 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3420 2ND ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5204
Practice Address - Country:US
Practice Address - Phone:347-209-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care