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General NPI Number Information
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NPI Number | 1982569877
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Entity Type | Organization
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Legal Business Name | FRONTIER HAVEN LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 906 E FRONTIER ST
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City | PAYSON
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State | AZ
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Zip | 85541-5709
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Country | US
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Telephone | 928-978-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 8046 W BARRANCA RD
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City | PAYSON
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State | AZ
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Zip | 85541-6681
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Country | US
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Telephone | 928-978-9191
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Fax | 928-978-9191
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. KERI JEAN EGBERT
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Credential |
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Telephone | 928-978-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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