Organization Name: | FRONTIER HOSPICE, LLC |
NPI Number: | 1770572737 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY D RUSSELL (ADMINISTRATOR) |
Mailing Address: | 4718 N Elizabeth St Suite A Pueblo |
State: | CO US |
Postal Code: | 810082079 |
Phone Number: | 7195445891 |
Fax Number: | 7195445895 |
NPI Enumeration Date: | 10/20/2005 |
NPI Last Update Date: | 12/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 17E478 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |