FIVE STAR QUALITY CARE-GA LLC NPI 1740229707

NPI Information

  • NPI: 1740229707
  • Provider Name: FIVE STAR QUALITY CARE-GA, LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: NORTHLAKE GARDENS
  • CLIA Number: 11D2005204
  • Address: 1300 MONTREAL RD
    TUCKER, GA
    ZIP 30084
  • Phone: (770) 934-0034

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NPI Details

FIVE STAR QUALITY CARE-GA, LLC is an assisted living facility in Tucker, GA. The provider is 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. FIVE STAR QUALITY CARE-GA, LLC NPI is 1740229707. The provider is registered as an organization entity type.
The provider Is Doing Business As Northlake Gardens.

The provider's business location address is:

1300 MONTREAL RD
TUCKER, GA
ZIP 30084-141
Phone: (770) 934-0034
Fax: (770) 934-0055

The provider's authorized official is Bruce J Mackey .
The authorized official title is President & Chief Executive Officer and has the following contact phone number (617) 796-8214.

The CLIA number assigned to this NPI record is 11D2005204 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/5/2006 and was last updated on 6/27/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility044-03-019-1GEORGIAYes

What is NPI?

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This page was last updated on: 11/21/2025

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