Organization
DIAMOND WILLOW LIVING LLC
Active
Other names
Diamond Willow
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNN GEVIK R.N. (COO)
(218) 625-2316
Entity
Organization
Contact information
Practice address
915 OLD HIGHWAY 2, PROCTOR, MN 55810-1750
(218) 625-2316
(218) 727-9559
Mailing address
11 E SUPERIOR ST, SUITE 508, DULUTH, MN 55802-2007
(218) 625-2316
(218) 727-9559
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
333803
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49-80621
MEDICA
MN
01
—
540106
FIRST PLAN OF MN
MN
Enumeration date
02/26/2007
Last updated
08/22/2020
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