Minnesota Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MINNESOTA SENIOR LIVING LLC

Practice address

3000 Douglas Dr N
Crystal, MN 55422-2452

Phone

(763) 544-6777

Fax

(763) 512-1772

NPI assigned

Dec 10, 2012

Organization subpart

Yes

Parent organization

PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWESTAs reported in NPPES

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

Authorized official

Name

Mark Mullen

Title

Director of Strategic Partnerships

Phone

(425) 559-6301

Specialties & licenses 1

Addresses

Other names 1

• Heathers Manor Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Minnesota Senior Living LLC4 organizations share this tax ID, including this one

Part of

Exter House

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Minnesota Senior Living LLC

  • Assisted Living Facility
  • Brooklyn Park, MN
  • NPI 1356686836
  NPD tax ID
• Minnesota Senior Living LLC

  • Assisted Living Facility
  • Brooklyn Park, MN
  • NPI 1548505027
  NPD tax ID
• Minnesota Senior Living LLC

  • Assisted Living Facility
  • Wayzata, MN
  • NPI 1720593353
  NPD tax ID

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

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492128000000",
    "number": "1780929257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 118TH AVE SE",
            "address_2": "110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980053819",
            "telephone_number": "425-559-6301",
            "fax_number": "425-559-6302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 DOUGLAS DR N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554222452",
            "telephone_number": "763-544-6777",
            "fax_number": "763-512-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA SENIOR LIVING LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST",
        "enumeration_date": "2012-12-10",
        "last_updated": "2017-04-14",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF STRATEGIC PARTNERSHIPS",
        "authorized_official_telephone_number": "425-559-6301"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heathers Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerri A McMahon
• Metropolitan Human Services, LLC
• Cynthia Jean Miller
• Mirnda Louise Miller
• Minneapolis Clinical Associates in Psychiatry LTD
• Minnesota Teen Challenge, Inc.
• Kowsar A Mohamed
• Muna Rasheed Mohamed
• Mustafa Mohamed
• Sudi Mohamed

• Assisted Living Facility in Crystal, MN
• Providers in Crystal, 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 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.