Provider Demographics
NPI:1932830783
Name:FRONTIERS IN CHANGE LLC
Entity Type:Organization
Organization Name:FRONTIERS IN CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW
Authorized Official - Phone:540-632-1434
Mailing Address - Street 1:5052 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3456
Mailing Address - Country:US
Mailing Address - Phone:540-632-1434
Mailing Address - Fax:707-679-4353
Practice Address - Street 1:1719 GRANDIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2815
Practice Address - Country:US
Practice Address - Phone:115-408-1956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health