Provider Demographics
NPI:1700832383
Name:FIVE STAR QUALITY CARE - NE INC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE - NE INC
Other - Org Name:CENTRAL CITY CARE CENTER
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 1:2720 17TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-9614
Mailing Address - Country:US
Mailing Address - Phone:308-946-3088
Mailing Address - Fax:308-946-2068
Practice Address - Street 1:2720 17TH AVENUE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9614
Practice Address - Country:US
Practice Address - Phone:308-946-3088
Practice Address - Fax:308-946-2068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE - NE INC
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
NE534001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
NE=========-00Medicaid