Provider Demographics
NPI:1538621396
Name:FIVE STAR RESIDENTIAL DAY SUPPORT
Entity type:Organization
Organization Name:FIVE STAR RESIDENTIAL DAY SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,CCRN
Authorized Official - Phone:757-642-4968
Mailing Address - Street 1:902 LUCAS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2749
Mailing Address - Country:US
Mailing Address - Phone:757-369-0290
Mailing Address - Fax:
Practice Address - Street 1:902 LUCAS CREEK RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2749
Practice Address - Country:US
Practice Address - Phone:757-369-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR RESIDENTIAL LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services