MEDICARE: UNITED FRONT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1467701219	OTHER	CA	ABA

General Provider Information

NPI Number	:	1407406465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED FRONT LLC

Provider Business Mailing Address
First Line	:	6955 N DURANGO DR STE 1115-375
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4411
Country	:	US
Telephone Number	:	281-413-6251
Fax Number	:

Provider Business Practice Location Address
First Line	:	6955 N DURANGO DR STE 1115-375
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4411
Country	:	US
Telephone Number	:	281-413-6251
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARL EATON
Credential	:
Telephone Number	:	281-413-6251

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	09/12/2019

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Directions to “UNITED FRONT LLC ” Practice Location

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