Gopher (Minnetonka) TRS LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GOPHER (MINNETONKA) TRS LLC

Doing business as

Havenwood of Minnetonka

Practice address

17710 Old Excelsior Blvd
Minnetonka, MN 55345-4113

Phone

(952) 209-1440

NPI assigned

Jan 12, 2022

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 Minnetonka 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": "1497406334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17710 OLD EXCELSIOR BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454113",
            "telephone_number": "952-209-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17710 OLD EXCELSIOR BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454113",
            "telephone_number": "952-209-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOPHER (MINNETONKA) 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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Havenwood of Minnetonka",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Chester Gonsiorek, PH.D.
• Mayda Caridad Gonzalez, APRN
• Roy Howard Good, CRNA
• Barbara Sue Goodman-Fischtrom, LICSW,LMFT,LADC
• Kinsey Goodman, NP
• Safiya A Gordon, A.R.N.P.
• Nicole Gorvin, ATR
• Roxanne Gosnell, AGNP
• Megan Frances Grabanski, MS, CCC-SLP
• Hailey Grace, APN

• Assisted Living Facility in Minnetonka, MN
• Providers in Minnetonka, 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.