Provider Demographics
NPI:1518913086
Name:FIVE STAR QUALITY CARE IA LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE IA LLC
Other - Org Name:WESTRIDGE QUALITY CARE & REHAB
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 1:600 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2444
Mailing Address - Country:US
Mailing Address - Phone:712-542-5161
Mailing Address - Fax:712-542-3430
Practice Address - Street 1:600 MANOR DR
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2444
Practice Address - Country:US
Practice Address - Phone:712-542-5161
Practice Address - Fax:712-542-3430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE IA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA730816314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805374Medicaid
IA0805374Medicaid