Healthcare Provider Details

I. General information

NPI: 1982569877
Provider Name (Legal Business Name): FRONTIER HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E FRONTIER ST
PAYSON AZ
85541-5709
US

IV. Provider business mailing address

8046 W BARRANCA RD
PAYSON AZ
85541-6681
US

V. Phone/Fax

Practice location:
  • Phone: 928-978-9191
  • Fax:
Mailing address:
  • Phone: 928-978-9191
  • Fax: 928-978-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERI JEAN EGBERT
Title or Position: MANAGING MEMBER
Credential:
Phone: 928-978-9191