Provider Demographics
NPI:1487975249
Name:FIVE STAR SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:FIVE STAR SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LEGGETT
Authorized Official - Last Name:MANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-243-2592
Mailing Address - Street 1:9019 RED BUD TRAIL
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8913
Mailing Address - Country:US
Mailing Address - Phone:704-243-2592
Mailing Address - Fax:704-243-2592
Practice Address - Street 1:9019 RED BUD TRAIL
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8913
Practice Address - Country:US
Practice Address - Phone:704-243-2592
Practice Address - Fax:704-243-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities