Five Star Brookside LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100551 Issued in KY

Legal business name

FIVE STAR BROOKSIDE LLC

Practice address

200 Brookside Dr
Louisville, KY 40243-1277

Phone

(502) 245-3048

Fax

(502) 244-6327

NPI assigned

May 24, 2006

Organization subpart

Yes

Parent organization

FIVE STAR BROOKSIDE 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 Brookside Doing business as

Part of

Five Star Brookside LLC

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1811942881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BROOKSIDE DRIVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40243",
            "telephone_number": "502-245-3048",
            "fax_number": "502-244-6327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BROOKSIDE DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431277",
            "telephone_number": "502-245-3048",
            "fax_number": "502-244-6327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR BROOKSIDE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR BROOKSIDE LLC",
        "enumeration_date": "2006-05-24",
        "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": "KY",
            "license": "100551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100122850",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Forum at Brookside",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Forum at Brookside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Shawn Fitzpatrick, MD
• Sarah Fitzpatrick
• Sharri Marie Fitzpatrick, APRN
• Sydney Fitzpatrick
• Tracy Fitzpatrick
• Five Star Rehabilitation and Wellness Services, LLC.
• Five Star Transportation
• Laura Hayman Fizer, D.M.D.
• Ted C Fizer, ARNP
• Alexandra Marie Flach, APRN

• Skilled Nursing Facility in Louisville, KY
• Providers in Louisville, KY by specialty
• Skilled Nursing Facility in Kentucky

• 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.