Organization
FIVE STAR DESERT HARBOR LLC
Active
Parent organization
FIVE STAR DESERT HARBOR LLC
Other names
The Forum at Desert Harbor
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIVE STAR DESERT HARBOR LLC
Authorized official
KATHERINE E POTTER (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(617) 796-8387
Entity
Organization
Contact information
Practice address
13840 N DESERT HARBOR DR, PEORIA, AZ 85381-3501
(623) 972-0995
(623) 977-5271
Mailing address
13840 N DESERT HARBOR DR, PEORIA, AZ 85381-3501
(623) 972-0995
(623) 977-5271
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI-421
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0401890
BLUE CROSS BLUE SHIELD OF
AZ
Enumeration date
04/18/2006
Last updated
03/28/2019
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