Provider Demographics
NPI:1902810625
Name:FIVE STAR LINCOLN HEIGHTS, LLC
Entity Type:Organization
Organization Name:FIVE STAR LINCOLN HEIGHTS, LLC
Other - Org Name:THE FORUM AT LINCOLN HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:311 WEST NOTTINGHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1824
Mailing Address - Country:US
Mailing Address - Phone:210-824-2314
Mailing Address - Fax:210-824-6556
Practice Address - Street 1:311 WEST NOTTINGHAM DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1824
Practice Address - Country:US
Practice Address - Phone:210-824-2314
Practice Address - Fax:210-824-6556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR LINCOLN HEIGHTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115736310400000X
TX116091314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
455870Medicare Oscar/Certification