Provider Demographics
NPI:1619324449
Name:FIVE STAR HEALTH LLC
Entity Type:Organization
Organization Name:FIVE STAR HEALTH LLC
Other - Org Name:FIVE STAR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-662-7500
Mailing Address - Street 1:14900 BOGLE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1799
Mailing Address - Country:US
Mailing Address - Phone:703-662-7500
Mailing Address - Fax:703-661-6937
Practice Address - Street 1:14900 BOGLE DR STE 310
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1799
Practice Address - Country:US
Practice Address - Phone:703-662-7500
Practice Address - Fax:703-661-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health