Healthcare Provider Details

I. General information

NPI: 1316191539
Provider Name (Legal Business Name): FIVE STAR LIVING OF ALEXANDRIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 VICTOR ST
ALEXANDRIA MN
56308-2479
US

IV. Provider business mailing address

11 E SUPERIOR ST SUITE 230
DULUTH MN
55802-2007
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1448
  • Fax:
Mailing address:
  • Phone: 218-625-2319
  • Fax: 218-625-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number340277
License Number StateMN

VIII. Authorized Official

Name: LYNN GEVIK
Title or Position: COO
Credential: RN
Phone: 218-625-2319