Diamond Willow Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

333803 Issued in MN

Legal business name

DIAMOND WILLOW LIVING LLC

Doing business as

Diamond Willow

Practice address

915 Old Highway 2
Proctor, MN 55810-1750

Phone

(218) 625-2316

Fax

(218) 727-9559

NPI assigned

Feb 26, 2007

Last updated

Aug 22, 2020By 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

Ms. Lynn Gevik, R.N.

Title

Coo

Phone

(218) 625-2316

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Diamond Willow Doing business as

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851427504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 E SUPERIOR ST",
            "address_2": "SUITE 508",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022007",
            "telephone_number": "218-625-2316",
            "fax_number": "218-727-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 OLD HIGHWAY 2",
            "city": "PROCTOR",
            "state": "MN",
            "postal_code": "558101750",
            "telephone_number": "218-625-2316",
            "fax_number": "218-727-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND WILLOW LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "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": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "333803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PLAN OF MN",
            "identifier": "540106",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "49-80621",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamond Willow",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Dixon Brown, BS
• Rachel Elaine Carlsen, APRN, CNP
• Erica Anne Chopskie, RN
• Brian Cox
• John William Crom, D.C.
• FCSL Proctor, LLC (Diamond Willow Assisted Living of Proctor)
• FCSL Proctor, LLC (Diamond Willow Assisted Living of Proctor)
• FCSL Proctor, LLC (Diamond Willow Assisted Living of Proctor)
• FCSL Proctor, LLC (Diamond Willow Assisted Living of Proctor)
• FCSL Proctor, LLC (Diamond Willow Assisted Living of Proctor)

• Assisted Living Facility in Proctor, MN
• Providers in Proctor, 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 Aug 22, 2020; 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.