Healthcare Provider Details

I. General information

NPI: 1427153121
Provider Name (Legal Business Name): FRAZEE CARE COMMUNITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W MAPLE AVE
FRAZEE MN
56544-4336
US

IV. Provider business mailing address

219 W MAPLE AVE
FRAZEE MN
56544-4336
US

V. Phone/Fax

Practice location:
  • Phone: 218-334-4501
  • Fax: 218-334-4500
Mailing address:
  • Phone: 218-334-4501
  • Fax: 218-334-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number330722
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4980495
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMEDICA WAIVER
# 2
Identifier7122681
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMEDICA INSURANCE
# 3
Identifier7100395
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMEDICA MSHO
# 4
Identifier5L06FR
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: TIM DUMPPROPE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 218-334-4501