Healthcare Provider Details

I. General information

NPI: 1922773183
Provider Name (Legal Business Name): FRONTLINE HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 LANDOVER RD STE 1
CHEVERLY MD
20785-1145
US

IV. Provider business mailing address

6505 OAK FOREST CT
CHEVERLY MD
20785-3167
US

V. Phone/Fax

Practice location:
  • Phone: 301-437-4344
  • Fax: 301-322-4886
Mailing address:
  • Phone: 301-437-4344
  • Fax: 301-322-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADAORA EDNA OGBUACHI
Title or Position: CEO
Credential: RN
Phone: 301-437-4344