Five Star Northshore LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

0013000 Issued in WI

Legal business name

FIVE STAR NORTHSHORE LLC

Practice address

10803 N Port Washington Rd
Mequon, WI 53092-5085

Phone

(262) 478-2200

NPI assigned

Apr 1, 2009

Organization subpart

Yes

Parent organization

FIVE STAR NORTHSHORE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce J. Mackey Jr.

Title

President & Chief Executive Officer

Phone

(617) 796-8214

Specialties & licenses 1

Addresses

Part of

Five Star Northshore LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1154563435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CENTRE ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024582094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10803 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925085",
            "telephone_number": "262-478-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR NORTHSHORE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR NORTHSHORE LLC",
        "enumeration_date": "2009-04-01",
        "last_updated": "2016-05-13",
        "status": "A",
        "authorized_official_last_name": "MACKEY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-796-8214",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": "0013000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenton H Field Jr., MD
• Kennedy Alexandria Finch
• Rebecca Fink-Leach, LPC, SAC-IT
• Madeline Finn, PA-C
• Fisher Family Chiropractic, S.C.
• Patricia Ann Flanagan, PHD
• Neena B Florsheim, PHD
• Kaitlin Fogeltanz, BCBA
• Trevor Folker, MS, LAT, ATC
• Christine Ann Foran, PSGT

• Assisted Living Facility in Mequon, WI
• Providers in Mequon, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.