MEDICARE: FRONT ST. 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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44AV	OTHER	CA	MEDI-CAL PRV NBR

General Provider Information

NPI Number	:	1922242734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT ST. INC.

Provider Business Mailing Address
First Line	:	303 POTRERO ST STE 42-102
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2779
Country	:	US
Telephone Number	:	831-420-0120
Fax Number	:	831-420-0136

Provider Business Practice Location Address
First Line	:	1201 SHAFFER RD
Second Line	:	BLDG 1, SUITE 1A
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-420-0120
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JONATHAN P BUTLER
Credential	:
Telephone Number	:	831-515-2393

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2024

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Directions to “FRONT ST. INC. ” Practice Location

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