Organization
FRASER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES D OLSON (CHIEF FINANCIAL OFFICER)
(612) 798-8320
Entity
Organization
Contact information
Practice address
2400 W 64TH ST, RICHFIELD, MN 55423-1001
(612) 861-1688
(612) 861-6050
Mailing address
2400 W 64TH ST, RICHFIELD, MN 55423-1001
(612) 861-1688
(612) 861-6050
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166355100
—
MN
Enumeration date
01/26/2007
Last updated
08/12/2021
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