Organization
FIVE STAR QUALITY CARE-WI, LLC
Active
Parent organization
FIVE STAR QUALITY CARE-WI, LLC
Other names
Mitchell Manor
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIVE STAR QUALITY CARE-WI, LLC
Authorized official
KATHERINE E POTTER (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(617) 796-8387
Entity
Organization
Contact information
Practice address
5301 WEST LINCOLN AVENUE, WEST ALLIS, WI 53219-1652
(414) 615-7200
(414) 615-7260
Mailing address
400 CENTRE STREET, NEWTON, MA 02458
(617) 796-8387
(617) 796-8385
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3181
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20201200
—
WI
Enumeration date
10/03/2005
Last updated
03/27/2019
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