MEDICARE: FRONT LINE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	10216	UT

General Provider Information

NPI Number	:	1326159948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT LINE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 57456
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-0456
Country	:	US
Telephone Number	:	801-746-3077
Fax Number	:	801-282-0304

Provider Business Practice Location Address
First Line	:	1800 S WEST TEMPLE
Second Line	:	SUITE A110
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-1851
Country	:	US
Telephone Number	:	801-746-3077
Fax Number	:	801-282-0304

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICK MEMMOTT
Credential	:
Telephone Number	:	801-746-3077

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “FRONT LINE SERVICES, INC. ” Practice Location

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