Five Star Quality Care Ia LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

780853 Issued in IA

Legal business name

FIVE STAR QUALITY CARE IA LLC

Practice address

34 Northcrest Dr
Council Bluffs, IA 51503-1622

Phone

(712) 328-2333

Fax

(712) 328-2960

NPI assigned

May 24, 2006

Organization subpart

Yes

Parent organization

FIVE STAR QUALITY CARE IA 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

• Northcrest Care & Rehabilitation Doing business as

Part of

Five Star Quality Care Ia LLC

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1750336806",
    "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": "34 NORTHCREST DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031622",
            "telephone_number": "712-328-2333",
            "fax_number": "712-328-2960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR QUALITY CARE IA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR QUALITY CARE IA LLC",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-05-29",
        "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": "IA",
            "license": "780853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805390",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northcrest Care & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maddison Paige Fidone, PA
• Breanna M Finley, APRN-NP
• Kristine Marie Fischer
• Alan Fisher, M.D.
• Christy Fisher, LMSW
• Flex Physical Therapy LLC
• Flex Physical Therapy LLC
• Thomas Kelly Flynn, DPT
• Focus-Family Options & Community Supports, Inc
• Foot and Ankle Center of Nebraska, P.C.

• Skilled Nursing Facility in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.