Healthcare Provider Details

I. General information

NPI: 1295674802
Provider Name (Legal Business Name): AHR BLOOMINGTON MN SH TRS SUB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 PORTLAND AVE S
BLOOMINGTON MN
55420-5408
US

IV. Provider business mailing address

18191 VON KARMAN AVE STE 300
IRVINE CA
92612-7106
US

V. Phone/Fax

Practice location:
  • Phone: 952-935-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL WILLHITE
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 949-270-9200