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General NPI Number Information
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NPI Number | 1184811101
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Entity Type | Organization
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Legal Business Name | FRASAT LLC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 3715 SAINT ANNS LN
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City | SAINT LOUIS
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State | MO
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Zip | 63121-4813
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Country | US
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Telephone | 314-383-3353
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Fax | 314-383-0454
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Provider Business Mailing Address
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Address Line | 2322 MUELLER LN
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1411
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Country | US
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Telephone | 314-630-2414
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Fax | 314-991-0096
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Authorized Official
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Title or Position | MEMBER MGMT
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Name | MR. ALI M CHAUDHRY
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Credential |
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Telephone | 314-383-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 034971
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License Number State | MO
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