Provider Demographics
NPI:1700945920
Name:FIVE STAR KNIGHTSBRIDGE, LLC
Entity Type:Organization
Organization Name:FIVE STAR KNIGHTSBRIDGE, LLC
Other - Org Name:HEALTHCARE CENTER AT THE FORUM
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:617-796-8387
Mailing Address - Street 1:4590 KNIGHTSBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4326
Mailing Address - Country:US
Mailing Address - Phone:614-451-6793
Mailing Address - Fax:614-273-2450
Practice Address - Street 1:4590 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4326
Practice Address - Country:US
Practice Address - Phone:614-451-6793
Practice Address - Fax:614-273-2450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR KNIGHTSBRIDGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
365775Medicare Oscar/Certification