Provider Demographics
NPI:1780181891
Name:FRONTIER TRAVEL, LLC
Entity Type:Organization
Organization Name:FRONTIER TRAVEL, LLC
Other - Org Name:FRONTIER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-445-5950
Mailing Address - Street 1:190 N PARK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1820
Mailing Address - Country:US
Mailing Address - Phone:973-445-5950
Mailing Address - Fax:
Practice Address - Street 1:190 N PARK ST APT 2
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1820
Practice Address - Country:US
Practice Address - Phone:973-445-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NJ251X00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid