Provider Demographics
NPI:1801313101
Name:FRAZIER RECOVERY HOME LLC
Entity type:Organization
Organization Name:FRAZIER RECOVERY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:REZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-895-4440
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-0142
Mailing Address - Country:US
Mailing Address - Phone:651-895-4440
Mailing Address - Fax:651-528-7030
Practice Address - Street 1:8813 HALE AVE S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-895-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN158041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty