MEDICARE: FRONTIER FAMILY SERVICES LLC

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1538333927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 1814
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-0006
Country	:	US
Telephone Number	:	804-658-4269
Fax Number	:

Provider Business Practice Location Address
First Line	:	2634 HUSSEY LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1107
Country	:	US
Telephone Number	:	804-658-4269
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LINWOOD JACOBS
Credential	:	ED.D
Telephone Number	:	804-301-1116

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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