Five Star Healthcare LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

540HHA-12 Issued in NV

Legal business name

FIVE STAR HEALTHCARE LLC

Practice address

6140 Coley Ave
Las Vegas, NV 89146-5211

Phone

(702) 248-4130

Fax

(702) 220-8735

NPI assigned

Aug 29, 2006

Organization subpart

No

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

Authorized official

Name

Marites Castillo Bustamante, RN BSN

Title

Administrator

Phone

(702) 248-4130

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1376652164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 COLEY AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891465211",
            "telephone_number": "702-248-4130",
            "fax_number": "702-220-8735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 COLEY AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891465211",
            "telephone_number": "702-248-4130",
            "fax_number": "702-220-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "CASTILLO BUSTAMANTE",
        "authorized_official_first_name": "MARITES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-248-4130",
        "authorized_official_credential": "RN BSN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NV",
            "license": "540HHA-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002902011",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mary Fixico

• Home Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Home Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.

Verify at the official NPI Registry.