1144426552 NPI number — FRONTIER COMMUNITY SERVICES

Table of content: (NPI 1144426552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144426552 NPI number — FRONTIER COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONTIER COMMUNITY SERVICES
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:
Provider Other Organization Name Type Code:
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:
1144426552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12127 PLEASANT VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-9785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-772-1396
Provider Business Mailing Address Fax Number:
740-772-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12127 PLEASANT VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601-9785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-772-1396
Provider Business Practice Location Address Fax Number:
740-772-1394
Provider Enumeration Date:
06/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARCARO
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
740-772-1396

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251V00000X , with the licence number: 0886135 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 411392 . This is a "OHIO DEPARTMENT OF AGING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7100158 . This is a "OHIO DEPARTMENT MRDD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0194957 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".