1477789907 NPI number — FRONT ST. INC.

Table of content: (NPI 1477789907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477789907 NPI number — FRONT ST. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONT ST. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHEELOCK MENTAL HEALTH SUPPORT SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477789907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95062-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-420-0120
Provider Business Mailing Address Fax Number:
831-420-0123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 WHEELOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-9719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-420-0120
Provider Business Practice Location Address Fax Number:
831-420-0123
Provider Enumeration Date:
06/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
ANN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CEO AND OWNER
Authorized Official Telephone Number:
831-420-0120

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44C1 . This is a "MEDI-CAL PRV NBR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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