Active NPI
Five Star Quality Care-in LLC
- Skilled Nursing Facility
- Bloomington, IN
National Provider Identifier
1285749754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- FIVE STAR QUALITY CARE-IN LLC
- Practice address
- 2455 Tamarack Trail
Bloomington, IN 47408-1294 - Phone
- (812) 336-7060
- Fax
- (812) 333-8917
- NPI assigned
- Aug 21, 2006
- Organization subpart
- Yes
- Parent organization
- FIVE STAR QUALITY CARE-IN 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 | |||
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
2455 Tamarack Trail
Bloomington, IN 47408-1294
Mailing address
2455 Tamarack Trail
Bloomington, IN 47408-1294
Phone (812) 336-7060
Other names 1
- Meadowood Health Pavilion
National Provider Directory
National Provider Directory- Part of
- Five Star Quality Care-in LLC
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Assisted Living Facility
- Indianapolis, IN
- NPI 1003545146
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1553731200000",
"number": "1285749754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2455 TAMARACK TRAIL",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081294",
"telephone_number": "812-336-7060",
"fax_number": "812-333-8917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2455 TAMARACK TRAIL",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081294",
"telephone_number": "812-336-7060",
"fax_number": "812-333-8917"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIVE STAR QUALITY CARE-IN LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FIVE STAR QUALITY CARE-IN LLC",
"enumeration_date": "2006-08-21",
"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": null,
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Meadowood Health Pavilion",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Meadowood Health Pavilion",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bloomington, IN
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.