Five Star Alternative Care Nursing Co

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

1040251-6-AFC Issued in MN

Legal business name

FIVE STAR ALTERNATIVE CARE NURSING CO

Practice address

6617 Stratford Road
Woodbury, MN 55125

Phone

(650) 814-0056

NPI assigned

Jul 7, 2011

Organization subpart

Yes

Parent organization

FIVE STAR ALTERNATIVE CARE NURSING COAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandra R Gavney

Title

Owner

Phone

(650) 814-0056

Specialties & licenses 1

Addresses

Part of

Five Star Alternative Care Nursing Co

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1982991279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WILDWOOD LANE",
            "city": "PALO",
            "state": "CA",
            "postal_code": "94303",
            "telephone_number": "650-814-0056",
            "fax_number": "650-739-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6617 STRATFORD ROAD",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "650-814-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR ALTERNATIVE CARE NURSING CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR ALTERNATIVE CARE NURSING CO",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "GAVNEY",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-814-0056"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MN",
            "license": "1040251-6-AFC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allyce Katherine Fisk, PA-C
• Rachel Lynn Fisk
• Sara Fiskum, PHARM. D.
• Grace Fitch
• Taliana Nala Fitzgerald
• Rebecca Claire Flaa
• Rachel Flaherty, MA, LMFT
• Megan Flaska, RD, LD
• Kyle Matthew Flaten, LAT, ATC
• Allison Fleming, DC

• Exclusive Provider Organization in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Exclusive Provider Organization in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; 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.