Provider Demographics
NPI:1447092515
Name:FRONTLINE RECOVERY LLC
Entity type:Organization
Organization Name:FRONTLINE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-298-3306
Mailing Address - Street 1:1600 18TH AVE NE UNIT 18744
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-5532
Mailing Address - Country:US
Mailing Address - Phone:612-298-3306
Mailing Address - Fax:
Practice Address - Street 1:4124 QUEBEC AVE N STE 104
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1200
Practice Address - Country:US
Practice Address - Phone:763-393-6194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder