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General NPI Number Information
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NPI Number | 1275284101
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Entity Type | Organization
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Legal Business Name | GOPHER (BURNSVILLE) TRS LLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 14401 GRAND AVE
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City | BURNSVILLE
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State | MN
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Zip | 55306-5709
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Country | US
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Telephone | 612-439-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 14401 GRAND AVE
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City | BURNSVILLE
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State | MN
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Zip | 55306-5709
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Country | US
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Telephone | 612-439-2510
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA SIMS
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Credential |
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Telephone | 214-754-8623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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