Five Star Support Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

FIVE STAR SUPPORT SERVICES LLC

Practice address

9019 Red Bud Trail
Waxhaw, NC 28173-8913

Phone

(704) 243-2592

Fax

(704) 243-2592

NPI assigned

Jun 16, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Marie Leggett Mangrum

Title

Owner - Director

Phone

(704) 243-2592

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1487975249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9019 RED BUD TRAIL",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281738913",
            "telephone_number": "704-243-2592",
            "fax_number": "704-243-2592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9019 RED BUD TRAIL",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281738913",
            "telephone_number": "704-243-2592",
            "fax_number": "704-243-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MANGRUM",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "LEGGETT",
        "authorized_official_title_or_position": "OWNER - DIRECTOR",
        "authorized_official_telephone_number": "704-243-2592",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.