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Organization
FIVE STAR LIVING OF LITTLE FALLS, LLC
Active
Organization
FIVE STAR LIVING OF LITTLE FALLS, LLC
Active
Other names
Diamond Willow
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN GEVIK R.N. (COO)
(218) 625-2319
Entity
Organization
Contact information
Practice address
1405 5TH AVE NE, LITTLE FALLS, MN 56345-2555
(218) 625-2319
Mailing address
11 E SUPERIOR ST, SUITE 230, DULUTH, MN 55802-2007
(218) 625-2319
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
339086
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180623000
STATE OF MN PROVIDER #
MN
01
—
887452000
STATE OF MINNESOTA PROVIDER #
MN
Enumeration date
05/29/2008
Last updated
05/29/2008
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