Organization
FIVE STAR BROOKSIDE LLC
Active
Parent organization
FIVE STAR BROOKSIDE LLC
Other names
The Forum at Brookside
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIVE STAR BROOKSIDE LLC
Authorized official
KATHERINE E POTTER (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(617) 796-8387
Entity
Organization
Contact information
Practice address
200 BROOKSIDE DR, LOUISVILLE, KY 40243-1277
(502) 245-3048
(502) 244-6327
Mailing address
200 BROOKSIDE DRIVE, LOUISVILLE, KY 40243
(502) 245-3048
(502) 244-6327
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100551
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100122850
—
KY
Enumeration date
05/24/2006
Last updated
03/28/2019
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