Provider Demographics
NPI:1932248507
Name:FIVE STAR DAY CARE
Entity type:Organization
Organization Name:FIVE STAR DAY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-291-0710
Mailing Address - Street 1:1041 STATE ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2533
Mailing Address - Country:US
Mailing Address - Phone:732-291-0710
Mailing Address - Fax:732-291-2970
Practice Address - Street 1:1041 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2533
Practice Address - Country:US
Practice Address - Phone:732-291-0710
Practice Address - Fax:732-291-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJFNP72Z311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8668701Medicaid