Provider Demographics
NPI:1447842893
Name:FRONTLINE, LLC
Entity type:Organization
Organization Name:FRONTLINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-524-2410
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:MOUNT MEIGS
Mailing Address - State:AL
Mailing Address - Zip Code:36057-0058
Mailing Address - Country:US
Mailing Address - Phone:762-524-2410
Mailing Address - Fax:
Practice Address - Street 1:1909 ROSA L PARKS AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108-3017
Practice Address - Country:US
Practice Address - Phone:334-398-4743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No251K00000XAgenciesPublic Health or Welfare