NPIMap

Organization Active NPI

Five Star Living LLC

Doing business as Diamond Willow

  • Assisted Living Facility
  • Detroit Lakes, MN
National Provider Identifier
1902093073
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
336184 Issued in MN
Legal business name
FIVE STAR LIVING LLC
Doing business as
Diamond Willow
Practice address
1558 Randolph Rd
Detroit Lakes, MN 56501-3745
Phone
(218) 625-2316
Fax
(218) 625-2338
NPI assigned
Oct 2, 2007
Last updated
Oct 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
Ms. Lymm Gevik, RN
Title
Coo
Phone
(218) 625-2316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 336184 MN Primary

Addresses

Primary practice location

1558 Randolph Rd
Detroit Lakes, MN 56501-3745

Mailing address

11 E Superior St
Suite 230
Duluth, MN 55802-2007
Phone (218) 625-2316

Other names 1

  • DIAMOND WILLOW Doing business as

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1902093073",
    "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": "1558 RANDOLPH RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013745",
            "telephone_number": "218-625-2316",
            "fax_number": "218-625-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "GEVIK",
        "authorized_official_first_name": "LYMM",
        "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",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.