Five Star Quality Care-Wi, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3181 Issued in WI

Legal business name

FIVE STAR QUALITY CARE-WI, LLC

Doing business as

Mitchell Manor

Practice address

5301 West Lincoln Avenue
West Allis, WI 53219-1652

Phone

(414) 615-7200

Fax

(414) 615-7260

NPI assigned

Oct 3, 2005

Last updated

Mar 27, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

FIVE STAR QUALITY CARE-WI, LLCAs reported in NPPES

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 1

Addresses

Other identifiers 1

Other names 1

• Mitchell Manor Doing business as

Part of

Meadowmere and Mitchell Manor Senior Living

Locations

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.

• Five Star Quality Care - Wi

  dba Meadowmere Madison

  • Assisted Living Facility
  • Madison, WI
  • NPI 1205083185
  NPPES parent name

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1417944612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CENTRE STREET",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "02458",
            "telephone_number": "617-796-8387",
            "fax_number": "617-796-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 WEST LINCOLN AVENUE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532191652",
            "telephone_number": "414-615-7200",
            "fax_number": "414-615-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR QUALITY CARE-WI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR QUALITY CARE-WI, LLC",
        "enumeration_date": "2005-10-03",
        "last_updated": "2019-03-27",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20201200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchell Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mitchell Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in West Allis, WI
• Providers in West Allis, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.