MEDICARE: HAVENWORTH ASSISTED LIVING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1073467551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVENWORTH ASSISTED LIVING INC

Provider Business Mailing Address
First Line	:	2717 CEDAR LN
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-2105
Country	:	US
Telephone Number	:	952-212-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 CEDAR LN
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-2105
Country	:	US
Telephone Number	:	952-212-3479
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MOHAMED AMIN JAMAL HASSAN
Credential	:
Telephone Number	:	952-212-3479

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

Similar Medicare Providers

1528227915 — OPTIONS RESIDENTIAL INC
Practice Location Address:

2105 W BURNSVILLE PKWY
BURNSVILLE, MN
55337-4237

Practice Phone: 952-564-3030
Practice Fax: 952-564-3038

1538390141 — OPTIONS RESIDENTIAL, INC
Practice Location Address:

2105 W BURNSVILLE PKWY
BURNSVILLE, MN
55337-4237

Practice Phone: 952-564-3030
Practice Fax: 952-564-3038

1326362583 — OPTIONS RESIDENTIAL, INC
Practice Location Address:

2105 W BURNSVILLE PKWY
BURNSVILLE, MN
55337-4237

Practice Phone: 952-564-3030
Practice Fax: 952-564-3038

1992029151 — MS. DIANE MARIE GREIG RN, MJN
Practice Location Address:

2105 W BURNSVILLE PKWY
BURNSVILLE, MN
55337-4237

Practice Phone: 952-564-3030
Practice Fax: 952-564-3038

1861543894 — STEPHANIE SLIGO-BAKER M.S.W
Practice Location Address:

2105 WEST 143RD STREET #B
BURNSVILLE, MN
55306-8000

Practice Phone: 952-303-6832
Practice Fax: 952-303-3434

1902579626 — BRENDA SIMASIKU RUSS
Practice Location Address:

2105 W 143RD ST # 2ND
BURNSVILLE, MN
55306-8000

Practice Phone: 952-303-6832
Practice Fax:

Directions to “HAVENWORTH ASSISTED LIVING INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.