High Drive Customized/Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

HIGH DRIVE CUSTOMIZED/ASSISTED LIVING LLC

Practice address

13813 High Dr
Burnsville, MN 55337-4740

Phone

(763) 228-1804

NPI assigned

Apr 24, 2023

Last updated

Apr 24, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Anbassa Hawiya Bukula, NA

Title

Program Manager (Owner)

Phone

(763) 228-1804

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1013605518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13813 HIGH DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374740",
            "telephone_number": "763-228-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13813 HIGH DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374740",
            "telephone_number": "763-228-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DRIVE CUSTOMIZED/ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "BUKULA",
        "authorized_official_first_name": "ANBASSA",
        "authorized_official_middle_name": "HAWIYA",
        "authorized_official_title_or_position": "PROGRAM MANAGER (OWNER)",
        "authorized_official_telephone_number": "763-228-1804",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.