Provider Demographics
NPI:1184231953
Name:FRONTIER HOME HEALTH CARE SOBER LIVING OF ARIZONA , CORP
Entity type:Organization
Organization Name:FRONTIER HOME HEALTH CARE SOBER LIVING OF ARIZONA , CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-229-1575
Mailing Address - Street 1:504 E HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4042
Mailing Address - Country:US
Mailing Address - Phone:907-229-1575
Mailing Address - Fax:866-413-7297
Practice Address - Street 1:8604 N 43RD DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5317
Practice Address - Country:US
Practice Address - Phone:907-229-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness