Provider Demographics
NPI:1518686690
Name:5 FIVE STAR, LLC
Entity Type:Organization
Organization Name:5 FIVE STAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HRACHUHI
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:PETIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-877-0003
Mailing Address - Street 1:8230 ALLOTT AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5502
Mailing Address - Country:US
Mailing Address - Phone:747-247-2027
Mailing Address - Fax:
Practice Address - Street 1:8230 ALLOTT AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5502
Practice Address - Country:US
Practice Address - Phone:650-483-9547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder