Provider Demographics
NPI:1295287118
Name:FRONTIER BEHAVIORAL HEALTH CENTER PLLC
Entity type:Organization
Organization Name:FRONTIER BEHAVIORAL HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-349-7475
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0280
Mailing Address - Country:US
Mailing Address - Phone:606-349-7475
Mailing Address - Fax:606-349-7476
Practice Address - Street 1:838 E MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-8378
Practice Address - Country:US
Practice Address - Phone:606-349-7475
Practice Address - Fax:606-349-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
KY800225261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100439840Medicaid
KY7100775640Medicaid