Healthcare Provider Details

I. General information

NPI: 1427657469
Provider Name (Legal Business Name): FRASER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 UNIVERSITY DR S
FARGO ND
58103-2648
US

IV. Provider business mailing address

2902 UNIVERSITY DR S
FARGO ND
58103-6032
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3301
  • Fax:
Mailing address:
  • Phone: 701-232-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1455821
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: AMANDA BARTON
Title or Position: DIRECTOR OF ACCOUNTING
Credential:
Phone: 701-232-3301