Organization
FIVE STAR QUALITY CARE WI LLC
Active
Parent organization
FIVE STAR QUALITY CARE WI LLC
Other names
Pine Manor Health Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIVE STAR QUALITY CARE WI LLC
Authorized official
BRUCE J MACKEY JR. (CEO)
(617) 796-8387
Entity
Organization
Contact information
Practice address
1625 E MAIN ST, VILLAGE OF EMBARRASS, CLINTONVILLE, WI 54929-9236
(715) 823-3135
(715) 823-1313
Mailing address
400 CENTRE ST, NEWTON, MA 02458
(617) 796-8387
(617) 796-8375
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3052
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21054400
—
WI
Enumeration date
05/23/2006
Last updated
05/19/2008
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