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General NPI Number Information
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NPI Number | 1164459988
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Entity Type | Organization
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Legal Business Name | FRONTIER MEDICAL HOME CARE INC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 217 A NORTH MAIN
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 505-627-1112
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Fax | 505-627-1113
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Provider Business Mailing Address
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Address Line | 217 A NORTH MAIN
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 505-627-1112
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Fax | 505-627-1113
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL D HOLT
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Credential |
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Telephone | 505-627-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 03003588000
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License Number State | NM
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