FIVE STAR RESIDENCES OF FORT WAYNE
NPI 1841365434
Assisted Living Facility in Fort Wayne, IN
- Organization
- Assisted Living Facility
- CLIA Number: 15D2149009
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 05-22-2028
About FIVE STAR RESIDENCES OF FORT WAYNE
This page provides the complete NPI Profile along with additional information for Five Star Residences Of Fort Wayne, a provider established in Fort Wayne, Indiana operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1841365434 assigned on November 2006. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Five Star Residences Of Fort Wayne. The authorized official of this NPI record is Katherine E Potter (President & Chief Executive Officer)
- NPI
- 1841365434 Verify this NPI
- Provider Legal Name
- FIVE STAR QUALITY CARE - OBX OPERATOR, LLC
- Other Organization Name
- FIVE STAR RESIDENCES OF FORT WAYNE
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 2601 COVINGTON COMMONS DRIVE FORT WAYNE, IN 46804
- Location Phone
- (260) 432-1932
- Location Fax
- (260) 432-7740
- Mailing Address
- 400 CENTRE STREET NEWTON, MA 02458
- Mailing Phone
- (617) 796-8387
- Mailing Fax
- (617) 796-8385
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 11-21-2006
- Last Update Date
- 06-23-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- 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.
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.
