Provider Demographics
NPI:1609045558
Name:FIVE STAR QUARTERS INC.
Entity Type:Organization
Organization Name:FIVE STAR QUARTERS INC.
Other - Org Name:FIVE STAR QUARTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-225-8872
Mailing Address - Street 1:4023 MEHALIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241
Mailing Address - Country:US
Mailing Address - Phone:972-225-8872
Mailing Address - Fax:
Practice Address - Street 1:4023 MEHALIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-5253
Practice Address - Country:US
Practice Address - Phone:972-225-8872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122690320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities