Provider Demographics
NPI:1982659819
Name:FIVE STAR QUALITY CARE-AZ LLC
Entity Type:Organization
Organization Name:FIVE STAR QUALITY CARE-AZ LLC
Other - Org Name:LA MESA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8292
Mailing Address - Street 1:2470 S ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8520
Mailing Address - Country:US
Mailing Address - Phone:928-344-8541
Mailing Address - Fax:
Practice Address - Street 1:2470 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8520
Practice Address - Country:US
Practice Address - Phone:928-344-8541
Practice Address - Fax:928-344-0823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR QUALITY CARE-AZ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI369314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ559841Medicaid
AZ559841Medicaid