Five Star Quality Care Wi LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3052 Issued in WI

Legal business name

FIVE STAR QUALITY CARE WI LLC

Doing business as

Pine Manor Health Care Center

Practice address

1625 E Main St
Village of Embarrass
Clintonville, WI 54929-9236

Phone

(715) 823-3135

Fax

(715) 823-1313

NPI assigned

May 23, 2006

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

Bruce J Mackey Jr.

Title

Ceo

Phone

(617) 796-8387

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Manor Health Care Center Doing business as

Part of

Five Star Quality Care-Wi LLC

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": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1649225392",
    "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": "02458",
            "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": "1625 E MAIN ST",
            "address_2": "VILLAGE OF EMBARRASS",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549299236",
            "telephone_number": "715-823-3135",
            "fax_number": "715-823-1313"
        }
    ],
    "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": "2006-05-23",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "MACKEY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-796-8387",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21054400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Manor Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Lynn Ferg, B.S., PTA
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• Abbie Laine Fetter, DC
• Five Star Quality Care
• Five Star Quality Care Wi LLC (Greentree Health and Rehabilitation Center)
• Michelle Marie Fowler, LPN
• Lesley A Fuerst, NP-C
• Gablian Skills Development LLC
• Leslie Gray, MD
• Griebenow Eyecare, S.C. (Griebenow Eyecare Clintonville)

• Skilled Nursing Facility in Clintonville, WI
• Providers in Clintonville, 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 May 19, 2008; 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.