Five Star Ellicott City LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

13AL166 Issued in MD

Legal business name

FIVE STAR ELLICOTT CITY LLC

Practice address

3004 N Ridge Rd
Ellicott City, MD 21043-3381

Phone

(410) 461-9494

Fax

(410) 461-8233

NPI assigned

Jun 17, 2006

Organization subpart

Yes

Parent organization

FIVE STAR ELLICOTT CITY 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

• Heartlands at Ellicott City Doing business as

Part of

Five Star Ellicott City LLC

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466985600000",
    "number": "1992740690",
    "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": "3004 N RIDGE RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433381",
            "telephone_number": "410-461-9494",
            "fax_number": "410-461-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR ELLICOTT CITY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR ELLICOTT CITY LLC",
        "enumeration_date": "2006-06-17",
        "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": "MD",
            "license": "13AL166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartlands at Ellicott City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Firstbrook, MA, CCC-SLP
• Carole Leigh Fischer, PT
• Julie Fischer, LCPC
• Julie Fisher
• Fit With Food LLC
• Five Star Rehabilitation and Wellness Services, LLC.
• Kyanni N. Fleming, RN, LMT
• Flourish Physical Therapy and Wellness LLC
• Flourish Telehealth
• Kimberly S Flyr, M.ED, LCPC

• Assisted Living Facility in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Assisted Living Facility in Maryland

• 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.