Provider Demographics
NPI:1467408179
Name:FIVE STAR QUALITY CARE - NE INC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE - NE INC
Other - Org Name:UTICA COMMUNITY CARE CENTER
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 1:1350 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NE
Mailing Address - Zip Code:68456-6094
Mailing Address - Country:US
Mailing Address - Phone:402-534-2041
Mailing Address - Fax:402-534-3546
Practice Address - Street 1:1350 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NE
Practice Address - Zip Code:68456-6094
Practice Address - Country:US
Practice Address - Phone:402-534-2041
Practice Address - Fax:402-534-3546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE - NE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE724004314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-05Medicaid
NE=========-05Medicaid