Healthcare Provider Details

I. General information

NPI: 1861818023
Provider Name (Legal Business Name): PHS BURNSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 W BURNSVILLE PKWY
BURNSVILLE MN
55337-4240
US

IV. Provider business mailing address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

V. Phone/Fax

Practice location:
  • Phone: 651-631-6100
  • Fax:
Mailing address:
  • Phone: 651-631-6432
  • Fax: 651-631-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number355860
License Number StateMN

VIII. Authorized Official

Name: MARK MEYER
Title or Position: CFO
Credential:
Phone: 651-631-6102