1760609044 NPI number — FRONT ST INC

Table of content: (NPI 1760609044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760609044 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:
DRAKE HOUSE MHSS
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:
1760609044
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:
831-420-0136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 FOAM ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-655-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007

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 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27BW8 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 44CF . This is a "MEDI-CAL PRV NBR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".