Provider Demographics
NPI:1689749939
Name:FRONTLINE RESIDENTIAL TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:FRONTLINE RESIDENTIAL TREATMENT CENTER LLC
Other - Org Name:NORTH STAR RESIDENTIAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO SR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:2530 DEBARR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2948
Mailing Address - Country:US
Mailing Address - Phone:907-258-7575
Mailing Address - Fax:
Practice Address - Street 1:MILE 2.5 CLARK WOLVERINE RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-258-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility