Healthcare Provider Details

I. General information

NPI: 1548573454
Provider Name (Legal Business Name): KWO 5 STAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MAIN ST N
NEW LONDON MN
56273-9572
US

IV. Provider business mailing address

102 GLENOAKS DRIVE
NEW LONDON MN
56273-9200
US

V. Phone/Fax

Practice location:
  • Phone: 320-354-5858
  • Fax: 320-354-2179
Mailing address:
  • Phone: 320-354-5858
  • Fax: 320-354-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA LEE BROWN
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 320-354-5858