Provider Demographics
NPI:1043906852
Name:5 STAR ADULT COMMUNITY CENTER
Entity type:Organization
Organization Name:5 STAR ADULT COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-223-4646
Mailing Address - Street 1:8514 FOREST VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-1104
Mailing Address - Country:US
Mailing Address - Phone:513-223-4646
Mailing Address - Fax:
Practice Address - Street 1:8514 FOREST VALLEY DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-1104
Practice Address - Country:US
Practice Address - Phone:513-223-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services