Healthcare Provider Details

I. General information

NPI: 1386189967
Provider Name (Legal Business Name): FRONTLINE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 PAYNE AVENUE
CLEVELAND OH
44114
US

IV. Provider business mailing address

1744 PAYNE AVENUE
CLEVELAND OH
44114
US

V. Phone/Fax

Practice location:
  • Phone: 216-623-6555
  • Fax: 216-623-6539
Mailing address:
  • Phone: 216-624-6555
  • Fax: 216-623-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPN
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLPN.057396.MEDS
License Number StateOH

VIII. Authorized Official

Name: MAUREEN SWEENEY
Title or Position: ASSISTANT DIRECTOR
Credential: CMP
Phone: 216-623-6555