NPIMap

Organization Active NPI

Five Star Quality Care - Obx Operator, LLC

Doing business as Five Star Residences of Fort Wayne

  • Assisted Living Facility
  • Fort Wayne, IN
National Provider Identifier
1841365434
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
FIVE STAR QUALITY CARE - OBX OPERATOR, LLC
Doing business as
Five Star Residences of Fort Wayne
Practice address
2601 Covington Commons Drive
Fort Wayne, IN 46804
Phone
(260) 432-1932
Fax
(260) 432-7740
NPI assigned
Nov 21, 2006
Last updated
Jun 23, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FIVE STAR QUALITY CARE - OBX OPERATOR, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

2601 Covington Commons Drive
Fort Wayne, IN 46804

Mailing address

400 Centre Street
Newton, MA 02458
Phone (617) 796-8387

Other names 1

  • Five Star Residences of Fort Wayne Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2149009Five Star Residences of Fort Wayne2601 Covington Commons Drive, Fort Wayne, IN 46804Certificate of waiverMay 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Five Star Quality Care9 organizations share this tax ID, including this one
Part of
Five Star Quality Care

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1841365434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CENTRE STREET",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "02458",
            "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": "2601 COVINGTON COMMONS DRIVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-432-1932",
            "fax_number": "260-432-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR QUALITY CARE - OBX OPERATOR, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR QUALITY CARE - OBX OPERATOR, LLC",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Five Star Residences of Fort Wayne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.