Provider Demographics
NPI:1922242734
Name:FRONT ST. INC.
Entity Type:Organization
Organization Name:FRONT ST. INC.
Other - Org Name:HOUSING SUPPORT TEAM
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-515-2393
Mailing Address - Street 1:303 POTRERO ST STE 42-102
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2779
Mailing Address - Country:US
Mailing Address - Phone:831-420-0120
Mailing Address - Fax:831-420-0136
Practice Address - Street 1:1201 SHAFFER RD
Practice Address - Street 2:BLDG 1, SUITE 1A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5761
Practice Address - Country:US
Practice Address - Phone:831-420-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT ST. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44AVOtherMEDI-CAL PRV NBR