Basic Information
| Provider Information | |||||||||
| NPI: | 1093798373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIVE STAR QUALITY CARE-KS, LLC | ||||||||
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| OtherOrganizationName: | BRANDON WOODS AT ALVAMAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 INVERNESS DRIVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660471870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858388000 | ||||||||
| FaxNumber: | 7858388001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 INVERNESS DRIVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660471870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858388000 | ||||||||
| FaxNumber: | 7858388001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | POTTER | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177968387 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 310400000X | N023009 | KS | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 310400000X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 311500000X | N023009 | KS | N | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | 314000000X | N023009 | KS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 200629080A | 05 | KS | MEDICAID |