Organization
GOPHER (MAPLE GROVE) TRS LLC
Active
Other names
Havenwood of Maple Glen
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA SIMS (PRESIDENT)
(214) 754-8623
Entity
Organization
Contact information
Practice address
18695 73RD AVE N, MAPLE GROVE, MN 55311-6604
(763) 363-8640
Mailing address
18695 73RD AVE N, MAPLE GROVE, MN 55311-6604
(763) 363-8640
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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