Provider Demographics
NPI:1700012101
Name:FRONTLINE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:FRONTLINE COMMUNITY SERVICES
Other - Org Name:FRONTLINE COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DITTU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLB
Authorized Official - Phone:301-588-0246
Mailing Address - Street 1:11720 BELTSVILLE DRIVE
Mailing Address - Street 2:#700
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-588-0246
Mailing Address - Fax:301-588-0222
Practice Address - Street 1:11720 BELTSVILLE DRIVE
Practice Address - Street 2:#700
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705
Practice Address - Country:US
Practice Address - Phone:301-588-0246
Practice Address - Fax:301-588-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-31
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 253Z00000X
MDD06690515251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC047852700Medicaid