Five Star Quality Care-Ia, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

FIVE STAR QUALITY CARE-IA, INC.

Doing business as

Park Place

Practice address

114 E Green St
Glenwood, IA 51534-1902

Phone

(712) 527-4841

Fax

(712) 527-3377

NPI assigned

Jun 7, 2006

Last updated

Apr 22, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

FIVE STAR QUALITY CARE-IA, INC.As reported in NPPES

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

Authorized official

Name

Bruce J. Mackey Jr.

Title

President & Chief Executive Officer

Phone

(617) 796-8214

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park Place Doing business as

Part of

Five Star Quality Care-Ia Inc

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461283200000",
    "number": "1558301606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CENTRE ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024582094",
            "telephone_number": "617-796-8387",
            "fax_number": "617-796-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 E GREEN ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515341902",
            "telephone_number": "712-527-4841",
            "fax_number": "712-527-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR QUALITY CARE-IA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR QUALITY CARE-IA, INC.",
        "enumeration_date": "2006-06-07",
        "last_updated": "2016-04-22",
        "status": "A",
        "authorized_official_last_name": "MACKEY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-796-8214",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0881565",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; 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.