Provider Demographics
NPI:1508271594
Name:MSL-MN ALF SERVICES
Entity Type:Organization
Organization Name:MSL-MN ALF SERVICES
Other - Org Name:DIAMOND WILLOW ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-625-2319
Mailing Address - Street 1:2701 W SUPERIOR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1856
Mailing Address - Country:US
Mailing Address - Phone:218-625-2319
Mailing Address - Fax:218-625-2338
Practice Address - Street 1:2701 W SUPERIOR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1856
Practice Address - Country:US
Practice Address - Phone:218-625-2319
Practice Address - Fax:218-625-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367057310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility