Provider Demographics
NPI:1598042749
Name:FIVE STAR HOME CARE
Entity Type:Organization
Organization Name:FIVE STAR HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-382-1003
Mailing Address - Street 1:702 SHERARD CIR
Mailing Address - Street 2:CIRCLE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2045
Mailing Address - Country:US
Mailing Address - Phone:859-382-1003
Mailing Address - Fax:
Practice Address - Street 1:702 SHERARD CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2045
Practice Address - Country:US
Practice Address - Phone:859-382-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care