Provider Demographics
NPI:1174035612
Name:FOREFRONT TELECARE INC
Entity type:Organization
Organization Name:FOREFRONT TELECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYER OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-735-8600
Mailing Address - Street 1:1717 MAIN ST STE 5850
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7317
Mailing Address - Country:US
Mailing Address - Phone:866-959-2008
Mailing Address - Fax:
Practice Address - Street 1:3500 QUAKERBRIDGE RD # 105
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1206
Practice Address - Country:US
Practice Address - Phone:609-480-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026830800Medicaid