1619219714 NPI number — FRONTIER HOME HEALTH AND HOSPICE, LLC

Table of content: (NPI 1619219714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619219714 NPI number — FRONTIER HOME HEALTH AND HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONTIER HOME HEALTH AND HOSPICE, LLC
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:
1619219714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 RIVER ST
Provider Second Line Business Mailing Address:
YANKEE PROFESSIONAL BUILDING
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460-3346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-693-3840
Provider Business Mailing Address Fax Number:
203-693-3841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 JASMINE ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
OMAK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98841-9501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-8621
Provider Business Practice Location Address Fax Number:
509-422-0131
Provider Enumeration Date:
03/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GESSFORD
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
203-693-3840

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  60077040 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1619219714 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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