Five Star Quality Care-Ga, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

044-03-019-1 Issued in GA

Legal business name

FIVE STAR QUALITY CARE-GA, LLC

Practice address

1300 Montreal Rd
Tucker, GA 30084-8141

Phone

(770) 934-0034

Fax

(770) 934-0055

NPI assigned

Jun 5, 2006

Organization subpart

Yes

Parent organization

FIVE STAR QUALITY CARE-GA, 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

President & Chief Executive Officer

Phone

(617) 796-8214

Specialties & licenses 1

Addresses

Other names 1

• Northlake Gardens Doing business as

Part of

Five Star Quality Care-Ga LLC

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466985600000",
    "number": "1740229707",
    "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": "617-796-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MONTREAL RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300848141",
            "telephone_number": "770-934-0034",
            "fax_number": "770-934-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR QUALITY CARE-GA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR QUALITY CARE-GA, LLC",
        "enumeration_date": "2006-06-05",
        "last_updated": "2016-06-27",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "044-03-019-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northlake Gardens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Tucker, GA
• Providers in Tucker, GA by specialty
• Assisted Living Facility in Georgia

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