Active NPI
Five Star Foulk Manor North LLC
Doing business as Foulk Manor North
- Skilled Nursing Facility
- Wilmington, DE
National Provider Identifier
1245256718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1058
- Legal business name
- FIVE STAR FOULK MANOR NORTH LLC
- Doing business as
- Foulk Manor North
- Practice address
- 1212 Foulk Rd
Wilmington, DE 19803-2741 - Phone
- (302) 478-4296
- Fax
- (302) 655-5451
- NPI assigned
- Jul 15, 2006
- Last updated
- Mar 28, 2019
- Organization subpart
- Yes
- Parent organization
- FIVE STAR FOULK MANOR NORTH LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Katherine E Potter
- Title
- President & Chief Executive Officer
- Phone
- (617) 796-8387
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 1306 | DE | |
| Skilled Nursing Facility | 314000000X | 1058 | DE | Primary |
Addresses
Primary practice location
1212 Foulk Rd
Wilmington, DE 19803-2741
Mailing address
400 Centre St
Newton, MA 02458-2094
Phone (617) 796-8387
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001188511 | Medicaid | DE |
Other names 1
- Foulk Manor North
National Provider Directory
National Provider Directory- Part of
- Five Star Foulk Manor North LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1553731200000",
"number": "1245256718",
"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",
"telephone_number": "617-796-8387",
"fax_number": "617-796-8375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 FOULK RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198032741",
"telephone_number": "302-478-4296",
"fax_number": "302-655-5451"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIVE STAR FOULK MANOR NORTH LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FIVE STAR FOULK MANOR NORTH LLC",
"enumeration_date": "2006-07-15",
"last_updated": "2019-03-28",
"status": "A",
"authorized_official_last_name": "POTTER",
"authorized_official_first_name": "KATHERINE",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "617-796-8387"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "DE",
"license": "1306",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "DE",
"license": "1058",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0001188511",
"state": "DE"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Foulk Manor North",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Foulk Manor North",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.