Healthcare Provider Details

I. General information

NPI: 1093256364
Provider Name (Legal Business Name): FRONTLINE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 PAYNE AVE
CLEVELAND OH
44114-2910
US

IV. Provider business mailing address

1744 PAYNE AVE
CLEVELAND OH
44114-2910
US

V. Phone/Fax

Practice location:
  • Phone: 216-651-9950
  • Fax: 216-651-9951
Mailing address:
  • Phone: 216-651-9950
  • Fax: 216-651-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPN137174-M-IV
License Number StateOH

VIII. Authorized Official

Name: MRS. KATHY RENNE BURNETT
Title or Position: MENTAL HEALTH NURSE
Credential: LPN
Phone: 216-651-9950