Provider Demographics
NPI:1740538982
Name:FRONTLINE INTERVENTION SOLUTION TODAY-ORGANIZATION LLC LIMITED LIABILI
Entity type:Organization
Organization Name:FRONTLINE INTERVENTION SOLUTION TODAY-ORGANIZATION LLC LIMITED LIABILI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHOENIX
Authorized Official - Suffix:SR
Authorized Official - Credentials:LAC ADDICTION COUNS
Authorized Official - Phone:913-999-5874
Mailing Address - Street 1:3211 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-3726
Mailing Address - Country:US
Mailing Address - Phone:913-999-5874
Mailing Address - Fax:913-999-5874
Practice Address - Street 1:3211 N 38TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-3726
Practice Address - Country:US
Practice Address - Phone:913-999-5874
Practice Address - Fax:913-999-5874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONTLINE INTERVENTION SOLUTION TODAY-ORGANIZATION LLC LIMITED LIABILI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLAC264324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility