Basic Information
| Provider Information | |||||||||
| NPI: | 1184640757 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FIVE STAR WOODLANDS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE FORUM AT THE WOODLANDS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024582094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172191400 | ||||||||
| FaxNumber: | 6177968243 | ||||||||
| Practice Location | |||||||||
| Address1: | 5055 W PANTHER CREEK DR | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773813500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812922600 | ||||||||
| FaxNumber: | 2812921836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | POTTER | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177968387 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FIVE STAR WOODLANDS LLC | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 113134 | TX | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 310400000X | 100813 | TX | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 310400000X | 113136 | TX | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.