Provider Demographics
NPI:1174725238
Name:FIVE STAR QUALITY CARE
Entity type:Organization
Organization Name:FIVE STAR QUALITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OCCUPATIONAL THERAPY ASSI
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRYLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-823-7194
Mailing Address - Street 1:70 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1009
Mailing Address - Country:US
Mailing Address - Phone:715-823-2194
Mailing Address - Fax:715-823-1306
Practice Address - Street 1:70 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1009
Practice Address - Country:US
Practice Address - Phone:715-823-2194
Practice Address - Fax:715-823-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI211-027314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40701600Medicaid