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General NPI Number Information
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NPI Number | 1609922194
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Entity Type | Organization
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Legal Business Name | FRASER CHILD AND FAMILY CENTER
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 3333 UNIVERSITY AVE SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3325
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Country | US
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Telephone | 612-331-9413
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Fax | 612-728-5301
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Provider Business Mailing Address
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Address Line | 2400 W 64TH ST
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City | RICHFIELD
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State | MN
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Zip | 55423-1001
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Country | US
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Telephone | 612-861-1688
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Fax | 612-861-6050
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JAMES D OLSON
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Credential |
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Telephone | 612-798-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 094026700
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Identifier Type | MEDICAID
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Identifier State | MN
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 094026700
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Identifier Type | MEDICAID
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Identifier State | MN
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Identifier Issuer |
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