FIVE STAR QUALITY CARE - OBX OPERATOR, LLC (NPI# 1841365434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841365434 |
| Entity Type | Organization |
| Organization Name | FIVE STAR QUALITY CARE - OBX OPERATOR, LLC |
| Other Organization Name | FIVE STAR RESIDENCES OF FORT WAYNE |
| Practice Address |
2601 Covington Commons Drive Fort Wayne IN 46804 |
| Mailing Address |
400 Centre Street Newton MA 02458 |
| Practice Telephone | 2604321932 |
| Practice Fax Number | 2604327740 |
| Mailing Telephone | 6177968387 |
| Mailing Fax Number | 6177968385 |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-06-23 |
| Authorized Official Name | KATHERINE E POTTER (PRESIDENT & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6177968387 |
| Is Organization Subpart | Y |
| Parent Organization Name | FIVE STAR QUALITY CARE - OBX OPERATOR, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Covington Commons | Doing Business As Name - Organization |
| Five Star Residences of Fort Wayne | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952536765 | Five Star Quality Care - Obx Operator, LLC | Assisted Living Facility | 3501 N Highway 81, Anderson, SC 29621-4419 | 2009-05-22 |
| 1508919101 | Five Star Quality Care - Obx Operator, LLC | Assisted Living Facility | 2500 Polo Ridge Ct, Winston-salem, NC 27106 | 2007-01-19 |
| 1194877001 | Five Star Quality Care - Obx Operator, LLC | Assisted Living Facility | 11230 Ballantyne Trace Court, Charlotte, NC 28277 | 2007-01-18 |
| 1992857007 | Five Star Quality Care - Obx Operator, LLC | Assisted Living Facility | 3896 North Elm Street, Greensboro, NC 27455 | 2007-01-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | FIVE STAR QUALITY CARE - OBX OPERATOR, LLC | 400 Centre St, Newton, MA 02458 |
| Street Address |
2601 COVINGTON COMMONS DRIVE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740895390 | The Health and Hospital Corporation of Marion County | Assisted Living Facility | 2002 Heritage Park Dr, Fort Wayne, IN 46805-5806 | 2020-09-10 |
| 1730712886 | Cook Road Aal Lp | Assisted Living Facility | 3731 W Cook Rd, Fort Wayne, IN 46818-9403 | 2020-02-18 |
| 1194358119 | Ev Fw Limited Partnership | Assisted Living Facility | 12523 Auburn Rd, Fort Wayne, IN 46845-8797 | 2020-02-18 |
| 1073006938 | Fort Wayne Aal Lp | Assisted Living Facility | 7125 S Hanna Street, Fort Wayne, IN 46816 | 2018-06-14 |
| 1801205240 | Pulaski Memorial Hospital | Assisted Living Facility | 5250 Heritage Pkwy, Fort Wayne, IN 46835-1061 | 2014-08-11 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1063701886 | Lamplight Inn of Fort Wayne, LLC | Assisted Living Facility | 300 E Washington Blvd, Fort Wayne, IN 46802-3124 | 2011-04-01 |
| 1396034237 | Park Place Senior Living, LLC | Assisted Living Facility | 4411 Park Place Dr, Fort Wayne, IN 46845-8793 | 2011-03-31 |
| 1225212475 | The Health and Hospital Corporation of Marion County | Assisted Living Facility | 7833 W. Jefferson Blvd, Fort Wayne, IN 46804 | 2007-12-24 |
| 1093900672 | Assisted Living Concepts Inc | Assisted Living Facility | 2116 Butler Road, Fort Wayne, IN 47150 | 2007-09-07 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on FIVE STAR QUALITY CARE - OBX OPERATOR, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.