Healthcare Provider Details

I. General information

NPI: 1366973414
Provider Name (Legal Business Name): FRONTLINE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 DETROIT AVE
CLEVELAND OH
44102-1805
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: 216-623-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberRN322679
License Number StateOH

VIII. Authorized Official

Name: MS. YOLANDA YVETTE NEAL
Title or Position: STAFF NURSE
Credential: RN
Phone: 216-651-9950