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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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