Provider Demographics
NPI:1164459988
Name:FRONTIER MEDICAL HOME CARE INC
Entity Type:Organization
Organization Name:FRONTIER MEDICAL HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-627-1112
Mailing Address - Street 1:217 A NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201
Mailing Address - Country:US
Mailing Address - Phone:505-627-1112
Mailing Address - Fax:505-627-1113
Practice Address - Street 1:217 A NORTH MAIN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:505-627-1112
Practice Address - Fax:505-627-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03003588000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06089798Medicaid
NMNM00HHA6OtherBLUE CROSS BLUE SHIELD OF
NM201069273OtherPRES SALUD
327181Medicare ID - Type Unspecified