HEATHERS MANOR
NPI 1780929257
Assisted Living Facility in Crystal, MN

Q: What is Minnesota Senior Living LLC's NPI number?

The NPI number for Minnesota Senior Living LLC is 1780929257. It was assigned to this organization in the NPPES registry on December 10, 2012. The provider is doing business as Heathers Manor.

Q: What is Minnesota Senior Living LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since December 10, 2012CLIA 24D2048719 · Waiver

3000 DOUGLAS DR N, CRYSTAL, MN 55422(763) 544-6777(763) 512-1772 Get Directions Write a Review

NPPES record last updated: April 14, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Heathers Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEATHERS MANOR (NPI 1780929257) is a healthcare organization registered as an assisted living facility in Crystal, Minnesota and active in the NPI registry since December 2012. The organization holds a CLIA Waiver certificate valid through October 21, 2026 and lists Mark Mullen, Director Of Strategic Partnerships, as its authorized official.

NPPES Registry Identity

NPI1780929257

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameMINNESOTA SENIOR LIVING LLC

Location Address3000 DOUGLAS DR NCrystal, MN 55422-2452

Mailing Address915 118th Ave Se, 110Bellevue, WA 98005-3819 · (425) 559-6301 · Fax (425) 559-6302

Phone(763) 544-6777

Fax(763) 512-1772

Organization SubpartYesParent: Presbyterian Retirement Communities Northwest

Authorized OfficialMark MullenDirector Of Strategic Partnerships · (425) 559-6301

Enumeration DateDecember 10, 2012

Last NPPES UpdateApril 14, 2017

✔ NPI 1780929257 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

3000 DOUGLAS DR N, Crystal, MN 55422

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Other Names 1

Doing Business AsHeathers Manor

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2048719

Heathers Manor · Crystal, MN

Active · expires Oct 21, 2026

CLIA Number24D2048719

Laboratory TypeAssisted Living Facility

Certificate Effective DateOctober 22, 2024

Certificate Expiration DateOctober 21, 2026

Laboratory DirectorJoan R. Oberg

Laboratory Phone(763) 544-6777

Laboratory LocationHeathers Manor3000 Douglas Drive No, Crystal, MN 55422

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Minnesota Senior Living LLC's NPI number?

The NPI number for Minnesota Senior Living LLC is 1780929257. It was assigned to this organization in the NPPES registry on December 10, 2012. The provider is doing business as Heathers Manor.

Where is Minnesota Senior Living LLC located?

Minnesota Senior Living LLC is located at 3000 Douglas Dr N, Crystal, MN 55422. The listed phone number is (763) 544-6777.

What is Minnesota Senior Living LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Minnesota Senior Living LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2048719) is associated with this NPI, valid through October 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Minnesota Senior Living LLC was last updated on April 14, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.