Provider Demographics
NPI:1023582574
Name:FIVE STAR HEALTHCARE
Entity type:Organization
Organization Name:FIVE STAR HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:757-473-9300
Mailing Address - Street 1:320 WESTSIDE STATION DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2839
Mailing Address - Country:US
Mailing Address - Phone:888-886-8054
Mailing Address - Fax:
Practice Address - Street 1:4867 BAXTER RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4469
Practice Address - Country:US
Practice Address - Phone:757-473-9300
Practice Address - Fax:757-473-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty