Five Stars Recovery Center

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

24D2130068 Issued in NU

Legal business name

FIVE STARS RECOVERY CENTER

Doing business as

Five Stars Clinical Laboratory

Practice address

1045 Stoughton Ave.
Chaska, MN 55318

Phone

(952) 448-6557

Fax

(952) 448-6047

NPI assigned

Aug 21, 2017

Last updated

Aug 21, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jason Vanderscoff, LADC

Title

Ceo, Managing Director

Phone

(952) 448-6557

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Five Stars Clinical Laboratory Doing business as

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503273600000",
    "number": "1194241166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 STOUGHTON AVE.",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "55318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 STOUGHTON AVE.",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "55318",
            "telephone_number": "952-448-6557",
            "fax_number": "952-448-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STARS RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2017-08-21",
        "status": "A",
        "authorized_official_last_name": "VANDERSCOFF",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO, MANAGING DIRECTOR",
        "authorized_official_telephone_number": "952-448-6557",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": "24D2130068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "473724996",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Five Stars Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca D Fedie, PT
• Martha Glas Field, LICSW
• Joy Irene Fischer, MSW, LICSW
• Catherine F. Fitterer, LICSW
• Five Star Recovery Center
• Marria Elizabeth Fjelstad
• Connor Ryan Flack, DPT, PT
• Megan Elizabeth Flynn, PHARMD
• Charlene Ann Forcier, MS, LMFT
• Fortress Mental Health

• Clinical Medical Laboratory in Chaska, MN
• Providers in Chaska, MN by specialty
• Clinical Medical Laboratory in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; 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.