Five Star Desert Harbor LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCI-421 Issued in AZ

Legal business name

FIVE STAR DESERT HARBOR LLC

Practice address

13840 N Desert Harbor Dr
Peoria, AZ 85381-3501

Phone

(623) 972-0995

Fax

(623) 977-5271

NPI assigned

Apr 18, 2006

Organization subpart

Yes

Parent organization

FIVE STAR DESERT HARBOR 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

• The Forum at Desert Harbor Doing business as

Part of

Five Star Desert Harbor LLC

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1528023033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13840 N DESERT HARBOR DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853813501",
            "telephone_number": "623-972-0995",
            "fax_number": "623-977-5271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13840 N DESERT HARBOR DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853813501",
            "telephone_number": "623-972-0995",
            "fax_number": "623-977-5271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR DESERT HARBOR LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR DESERT HARBOR LLC",
        "enumeration_date": "2006-04-18",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "AZ0401890",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Forum at Desert Harbor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Forum at Desert Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fisher Medical Group LTD
• Catherine Anne Fisher, MD
• Jessica Fisher, LCSW
• Richard David Fisher, M.D.
• Kassanda Marie Fitzmaurice
• Elissa Fjeldheim
• Sarah Fladager
• Josephine Flancbaum, RN
• Michael Patrick Fleming
• Melissa Flesch, PA

• Skilled Nursing Facility in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Skilled Nursing Facility in Arizona

• 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.

Verify at the official NPI Registry.