# FIVE STAR SUPPORT SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487975249
- **Authorized official:** MRS. MARIE LEGGETT MANGRUM (OWNER - DIRECTOR)
- **Authorized official phone:** (704) 243-2592

## Contact information

- **Practice address:** 9019 RED BUD TRAIL, WAXHAW, NC 28173-8913
- **Practice address phone:** (704) 243-2592
- **Practice address fax:** (704) 243-2592
- **Mailing address:** 9019 RED BUD TRAIL, WAXHAW, NC 28173-8913
- **Mailing address phone:** (704) 243-2592
- **Mailing address fax:** (704) 243-2592

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NC | Yes |

## Other

- **Enumeration date:** 06/16/2010
- **Last updated:** 07/21/2022