Provider Demographics
NPI:1760591358
Name:FIVE STAR QUALITY CARE FL LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE FL LLC
Other - Org Name:COURT AT PALM AIRE
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:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:2701 NORTH COURSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3089
Mailing Address - Country:US
Mailing Address - Phone:954-975-8900
Mailing Address - Fax:954-975-8933
Practice Address - Street 1:2701 NORTH COURSE DRIVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3058
Practice Address - Country:US
Practice Address - Phone:954-975-8900
Practice Address - Fax:954-975-8933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE FL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15550962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031879500Medicaid
FL031879500Medicaid