Provider Demographics
NPI:1245279256
Name:FIVE STAR CORAL SPRINGS LLC
Entity type:Organization
Organization Name:FIVE STAR CORAL SPRINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:8500 ROYAL PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5715
Mailing Address - Country:US
Mailing Address - Phone:954-752-9500
Mailing Address - Fax:954-755-9559
Practice Address - Street 1:8500 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5715
Practice Address - Country:US
Practice Address - Phone:954-752-9500
Practice Address - Fax:954-755-9559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR CORAL SPRINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1430095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001806600Medicaid
FL001806600Medicaid