Green Haven Irts LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

GREEN HAVEN IRTS LLC

Practice address

513 Wood Way
Burnsville, MN 55337-5732

Phone

(763) 485-1011

NPI assigned

Nov 12, 2024

Organization subpart

No

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

Authorized official

Name

Mohamoud Egal

Title

Ceo

Phone

(651) 347-1747

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1598589038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W STE 203",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374445",
            "telephone_number": "763-485-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 WOOD WAY",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375732",
            "telephone_number": "763-485-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN HAVEN IRTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-12",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "EGAL",
        "authorized_official_first_name": "MOHAMOUD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-347-1747"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Marie Graves, PT, DPT, CLT
• Kristen Nicole Graves, D.C.
• David Gray, MD
• Jeanine M. Gray, PTA
• Great Northern Health Products Co
• Megan Greengard
• Alyssa Gregory
• Mariah Gregory
• Bridget Alyssa Greiber
• Diane Marie Greig, RN, MJN

• Psychiatric Residential Treatment Facility in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Psychiatric Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.