Five Star Living of Park Rapids, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

336724 Issued in MN

Legal business name

FIVE STAR LIVING OF PARK RAPIDS, LLC

Practice address

911 Crocus Hill Street
Birch Park Suites
Park Rapids, MN 56470

Phone

(218) 625-2316

Fax

(218) 625-2338

NPI assigned

Nov 28, 2007

Organization subpart

Yes

Parent organization

FIVE STAR LIVING, LLCAs reported in NPPES

Name

Lynn Gevik, RN

Title

Coo

Phone

(218) 625-2316

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Five Star Living LLC

  • Assisted Living Facility
  • Detroit Lakes, MN
  • NPI 1902093073
  NPPES parent name

Organizations that report the same tax identification number in the National Provider Directory.

• Five Star Living of Park Rapids, LLC

  • Assisted Living Facility
  • Park Rapids, MN
  • NPI 1659553170
  NPD tax ID

Tax ID family

Diamond Willow Assisted Living (2 organizations share this tax ID)

Part of

Five Star Living LLC

Locations

• DIAMOND WILLOW ASSISTED LIVING Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 28, 2007.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1629250063",
    "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": "218-625-2316",
            "fax_number": "218-625-2338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 CROCUS HILL STREET",
            "address_2": "BIRCH PARK SUITES",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "56470",
            "telephone_number": "218-625-2316",
            "fax_number": "218-625-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR LIVING OF PARK RAPIDS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR LIVING, LLC",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "GEVIK",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-625-2316",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "336724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIAMOND WILLOW ASSISTED LIVING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael E Erickson, DC
• Vern Erickson, M.D.
• Deborah Jeanne Farrell, LICSW
• FCSL Park Rapids, LLC
• FCSL Park Rapids, LLC
• Five Star Living of Park Rapids, LLC
• Constance Margaret Ford
• Heather Foresman, APRN,CNM
• Codruta Iuliana Fosman, DDS
• Burton P Fosse Jr., CRNA

• All providers in Park Rapids, MN
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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.