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General NPI Number Information
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NPI Number | 1740538982
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Entity Type | Organization
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Legal Business Name | FRONTLINE INTERVENTION SOLUTION TODAY-ORGANIZATION LLC LIMITED LIABILI
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 3211 N 38TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66104-3726
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Country | US
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Telephone | 913-999-5874
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Fax | 913-999-5874
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Provider Business Mailing Address
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Address Line | 3211 N 38TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66104-3726
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Country | US
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Telephone | 913-999-5874
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Fax | 913-999-5874
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Authorized Official
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Title or Position | C.E.O
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Name | MR. JIMMIE C. PHOENIX SR.
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Credential | LAC ADDICTION COUNS
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Telephone | 913-999-5874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | LAC264
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License Number State | KS
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