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Organization
FIVE STAR LIVING OF ALEXANDRIA
Active
Organization
FIVE STAR LIVING OF ALEXANDRIA
Active
Other names
Diamond Willow Assisted Living of Alexandria
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN GEVIK RN (COO)
(218) 625-2319
Entity
Organization
Contact information
Practice address
803 VICTOR ST, ALEXANDRIA, MN 56308-2479
(320) 762-1448
Mailing address
11 E SUPERIOR ST, SUITE 230, DULUTH, MN 55802-2007
(218) 625-2319
(218) 625-2338
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
340277
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A367147100
STATE OF MN PROVIDER #
MN
Enumeration date
11/14/2008
Last updated
11/14/2008
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