# FIVE STAR BROOKSIDE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FIVE STAR BROOKSIDE LLC
- **Other names:** The Forum at Brookside
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1811942881
- **Legal business name:** FIVE STAR BROOKSIDE LLC
- **Authorized official:** KATHERINE E POTTER (PRESIDENT & CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (617) 796-8387

## Contact information

- **Practice address:** 200 BROOKSIDE DR, LOUISVILLE, KY 40243-1277
- **Practice address phone:** (502) 245-3048
- **Practice address fax:** (502) 244-6327
- **Mailing address:** 200 BROOKSIDE DRIVE, LOUISVILLE, KY 40243
- **Mailing address phone:** (502) 245-3048
- **Mailing address fax:** (502) 244-6327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100551 | KY | Yes |

## Other

- **Enumeration date:** 05/24/2006
- **Last updated:** 03/28/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100122850 | — | KY |