Five Star Living of Alexandria

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

340277 Issued in MN

Legal business name

FIVE STAR LIVING OF ALEXANDRIA

Doing business as

Diamond Willow Assisted Living of Alexandria

Practice address

803 Victor St
Alexandria, MN 56308-2479

Phone

(320) 762-1448

NPI assigned

Nov 14, 2008

Last updated

Nov 14, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lynn Gevik, RN

Title

Coo

Phone

(218) 625-2319

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diamond Willow Assisted Living of Alexandria Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226620800000",
    "number": "1316191539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 E SUPERIOR ST",
            "address_2": "SUITE 230",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022007",
            "telephone_number": "218-625-2319",
            "fax_number": "218-625-2338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 VICTOR ST",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563082479",
            "telephone_number": "320-762-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR LIVING OF ALEXANDRIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2008-11-14",
        "status": "A",
        "authorized_official_last_name": "GEVIK",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-625-2319",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "340277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MN PROVIDER #",
            "identifier": "A367147100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamond Willow Assisted Living of Alexandria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Fields
• Connie Lou Fields, RN
• Aaron Matthew Finley, PHARMD
• Firefly Speech & Language Therapy LLC
• Kayla Fischer, LAT, ATC
• Sarah L Flaten, MS, LMFT
• John Tyler Flatt, M.S., A.T.C.
• Shan M Flatt, MD
• Paul C Florell, MD
• Melissa Foss

• Assisted Living Facility in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.