Provider Demographics
NPI:1851439665
Name:UNLIMITED FRONTIERS
Entity Type:Organization
Organization Name:UNLIMITED FRONTIERS
Other - Org Name:LARAMIE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-793-0142
Mailing Address - Street 1:PO BOX 7722
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0722
Mailing Address - Country:US
Mailing Address - Phone:909-793-0142
Mailing Address - Fax:909-335-6193
Practice Address - Street 1:1467 LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4181
Practice Address - Country:US
Practice Address - Phone:909-793-0142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60217FOtherMEDICAL
CA05-G269Medicaid