Provider Demographics
NPI:1922054956
Name:FIVE STAR QUALITY CARE-COLORADO LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE-COLORADO LLC
Other - Org Name:MANTEY HEIGHTS REHABILITATION & 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:617-799-8387
Mailing Address - Street 1:2825 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-6065
Mailing Address - Country:US
Mailing Address - Phone:970-242-7356
Mailing Address - Fax:970-245-9196
Practice Address - Street 1:2825 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-6065
Practice Address - Country:US
Practice Address - Phone:970-245-1211
Practice Address - Fax:970-245-4437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE-COLORADO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1144314000000X
CO385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58301747Medicaid
065307Medicare Oscar/Certification