Five Star Living of Cloquet LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

336184 Issued in MN

Legal business name

FIVE STAR LIVING OF CLOQUET LLC

Doing business as

Diamond Willow Assisted Living

Practice address

130 North Rd
Cloquet, MN 55720-1171

Phone

(218) 625-2316

Fax

(218) 625-2338

NPI assigned

Feb 15, 2008

Last updated

Feb 15, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

FIVE STAR ASSISTED LIVING LLCAs reported in NPPES

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

Authorized official

Name

Ms. Lynn Gevik, RN

Title

Coo

Phone

(218) 625-2316

Specialties & licenses 1

Addresses

Other names 1

• DIAMOND WILLOW ASSISTED LIVING Doing business as

Tax ID family

Diamond Willow2 organizations share this tax ID, including this one

Part of

Five Star Assisted Living Services LLC

Other organizations with this tax ID 1

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

• Five Star Living of Cloquet, LLC

  dba Diamond Willow

  • Assisted Living Facility
  • Cloquet, MN
  • NPI 1225251556
  NPD tax ID

Locations

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1639347354",
    "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": "130 NORTH RD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201171",
            "telephone_number": "218-625-2316",
            "fax_number": "218-625-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR LIVING OF CLOQUET LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR ASSISTED LIVING LLC",
        "enumeration_date": "2008-02-15",
        "last_updated": "2008-02-15",
        "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_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "336184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIAMOND WILLOW ASSISTED LIVING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Nicole Fenn
• Madison Renee Fetters
• Chad Fey, MD
• Leaola Fields, NP
• First Steps Pediatric Physical Therapy, LLC
• Five Star Living of Cloquet, LLC (Diamond Willow)
• Solitaire Fjosne
• Fond Du Lac Reservation Business Committe (Fond du Lac Human Services Division Dental Clinic)
• Fond Du Lac Reservation Business Committee
• Fond Du Lac Reservation Business Committee (Fond du Lac Assisted Living)

• Assisted Living Facility in Cloquet, MN
• Providers in Cloquet, 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 Feb 15, 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.