Gopher (Burnsville) TRS LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GOPHER (BURNSVILLE) TRS LLC

Doing business as

Havenwood of Burnsville

Practice address

14401 Grand Ave
Burnsville, MN 55306-5709

Phone

(612) 439-2510

NPI assigned

Jan 12, 2022

Last updated

Jan 12, 2022By 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

Laura Sims

Title

President

Phone

(214) 754-8623

Specialties & licenses 1

Addresses

Other names 1

• Havenwood of Burnsville Doing business as

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1275284101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14401 GRAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553065709",
            "telephone_number": "612-439-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14401 GRAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553065709",
            "telephone_number": "612-439-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOPHER (BURNSVILLE) TRS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-754-8623"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Havenwood of Burnsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Angie Lynn Grabau
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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 Jan 12, 2022; 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.