Provider Demographics
NPI:1548573454
Name:KWO 5 STAR, INC
Entity Type:Organization
Organization Name:KWO 5 STAR, INC
Other - Org Name:LAKE REGION HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-354-5858
Mailing Address - Street 1:102 GLENOAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MN
Mailing Address - Zip Code:56273-9200
Mailing Address - Country:US
Mailing Address - Phone:320-354-5858
Mailing Address - Fax:320-354-2179
Practice Address - Street 1:220 MAIN ST N
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-9572
Practice Address - Country:US
Practice Address - Phone:320-354-5858
Practice Address - Fax:320-354-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN498454400Medicaid
MN247133Medicare UPIN