Provider Demographics
NPI:1780939132
Name:FIVE STAR ASSISTED LIVING SERVICES, LLC
Entity type:Organization
Organization Name:FIVE STAR ASSISTED LIVING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELEZNIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-625-8488
Mailing Address - Street 1:2701 W. SUPERIOR STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806
Mailing Address - Country:US
Mailing Address - Phone:218-625-2319
Mailing Address - Fax:218-625-2338
Practice Address - Street 1:6353 E SUPERIOR STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2545
Practice Address - Country:US
Practice Address - Phone:218-625-2319
Practice Address - Fax:218-625-2338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR ASSISTED LIVING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-20
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN358130310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility