Provider Demographics
NPI:1194881623
Name:FRONTIER HEALTH
Entity type:Organization
Organization Name:FRONTIER HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING/ COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:CRISTI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:423-467-3741
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:1167 SPRATLIN PARK DRIVE
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:1006 US HIGHWAY 23N
Practice Address - Street 2:
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290
Practice Address - Country:US
Practice Address - Phone:276-225-0976
Practice Address - Fax:423-467-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA315-16-001251B00000X
VA315-07-004261QM0801X, 261QR0405X
VA315-05-001261QM0801X, 261QM0801X
VA315-03-001385H00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-4924-2Medicaid
VA49-4924-2Medicaid