FIVE STAR RESIDENCES OF FORT WAYNE
NPI 1841365434
Assisted Living Facility in Fort Wayne, IN

Active since November 21, 2006CLIA 15D2149009 · Waiver
2601 COVINGTON COMMONS DRIVE, FORT WAYNE, IN 46804(260) 432-1932(260) 432-7740 Get Directions Write a Review

NPPES record last updated: June 23, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Five Star Residences Of Fort Wayne NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FIVE STAR RESIDENCES OF FORT WAYNE (NPI 1841365434) is a healthcare organization registered as an assisted living facility in Fort Wayne, Indiana and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through May 22, 2028 and lists Katherine E Potter, President & Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1841365434
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameFIVE STAR QUALITY CARE - OBX OPERATOR, LLC
Location Address2601 COVINGTON COMMONS DRIVEFort Wayne, IN 46804
Mailing Address400 Centre StreetNewton, MA 02458 · (617) 796-8387 · Fax (617) 796-8385
Fax(260) 432-7740
Organization SubpartYes
Authorized OfficialKatherine E PotterPresident & Chief Executive Officer · (617) 796-8387
Enumeration DateNovember 21, 2006
Last NPPES UpdateJune 23, 2020
NPPES CertifiedJune 23, 2020
NPI 1841365434 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

2601 COVINGTON COMMONS DRIVE, Fort Wayne, IN 46804

Other Names 1

Doing Business AsFive Star Residences Of Fort Wayne

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
15D2149009
Facility Type
Assisted Living Facility
Certificate Effective Date
May 23, 2026
Certificate Expiration Date
May 22, 2028
Laboratory Director
NIKKI ROGERS
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Five Star Residences Of Fort Wayne to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for FIVE STAR RESIDENCES OF FORT WAYNE

There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1841365434, enumerated as an "organization" on November 21, 2006.

The provider is located at 2601 COVINGTON COMMONS DRIVE FORT WAYNE, IN 46804 and the phone number is (260) 432-1932.

Assisted Living Facility with taxonomy code 310400000X.