Provider Demographics
NPI:1114552288
Name:FRONTIER HOME HEALTH, LLC
Entity Type:Organization
Organization Name:FRONTIER HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-544-5891
Mailing Address - Street 1:4718 N ELIZABETH ST STE A
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2080
Mailing Address - Country:US
Mailing Address - Phone:719-544-5891
Mailing Address - Fax:
Practice Address - Street 1:4718 N ELIZABETH ST STE A
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2080
Practice Address - Country:US
Practice Address - Phone:719-544-5891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONTIER HOME HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health