Provider Demographics
NPI:1245068089
Name:FRONTIER ST. ELIAS LLC
Entity type:Organization
Organization Name:FRONTIER ST. ELIAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNNETTER
Authorized Official - Last Name:DEFOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-990-9911
Mailing Address - Street 1:1015 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4306
Mailing Address - Country:US
Mailing Address - Phone:541-990-9911
Mailing Address - Fax:907-328-2203
Practice Address - Street 1:1015 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4306
Practice Address - Country:US
Practice Address - Phone:541-990-9911
Practice Address - Fax:907-328-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility