MEDICARE: KWO 5 STAR, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548573454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWO 5 STAR, INC

Provider Business Mailing Address
First Line	:	102 GLENOAKS DRIVE
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9200
Country	:	US
Telephone Number	:	320-354-5858
Fax Number	:	320-354-2179

Provider Business Practice Location Address
First Line	:	220 MAIN ST N
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9572
Country	:	US
Telephone Number	:	320-354-5858
Fax Number	:	320-354-2179

Authorized Official
Title or Position	:	FINANCIAL DIRECTOR
Name	:	MRS. LAURA LEE BROWN
Credential	:
Telephone Number	:	320-354-5858

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	06/09/2011

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Directions to “KWO 5 STAR, INC ” Practice Location

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