Healthcare Provider Details

I. General information

NPI: 1265618581
Provider Name (Legal Business Name): FRONTIER FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 BOSTON AVE
LONGMONT CO
80501-1707
US

IV. Provider business mailing address

1290 BOSTON AVE
LONGMONT CO
80501-1707
US

V. Phone/Fax

Practice location:
  • Phone: 303-702-0952
  • Fax: 303-702-0956
Mailing address:
  • Phone: 303-702-0952
  • Fax: 303-702-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number38041
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number38041
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number38041
License Number StateCO

VIII. Authorized Official

Name: CAROL E. GATES
Title or Position: ASST. DIRECTOR
Credential:
Phone: 303-702-0952