Basic Information
| Provider Information | |||||||||
| NPI: | 1790027480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRONTIER HOME HEALTH AND HOSPICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 RIVER ST | ||||||||
| Address2: | YANKEE PROFESSIONAL BUILDING | ||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064603346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036933840 | ||||||||
| FaxNumber: | 2036933841 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 JASMINE ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | OMAK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988419501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094226721 | ||||||||
| FaxNumber: | 5094221835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2013 | ||||||||
| LastUpdateDate: | 02/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | GESSFORD | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 2036933840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 60066213 | WA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1790027480 | 05 | WA | MEDICAID |