Provider Demographics
NPI:1023460342
Name:5 STAR RESIDENTIAL CARE
Entity type:Organization
Organization Name:5 STAR RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAPTIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-926-0133
Mailing Address - Street 1:3116 BUNCH WALNUTS RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2904
Mailing Address - Country:US
Mailing Address - Phone:757-204-4655
Mailing Address - Fax:757-282-2697
Practice Address - Street 1:5024 KELSO ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2391
Practice Address - Country:US
Practice Address - Phone:336-926-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health