Organization
PRAIRIECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL OBERSTAR M.D. (CEO)
(763) 383-5800
Entity
Organization
Contact information
Practice address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(952) 826-8405
Mailing address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(952) 826-8405
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
26-3715906
MN
Other
Enumeration date
10/12/2011
Last updated
10/12/2011
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