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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