Provider Demographics
NPI:1346069747
Name:FR5 VENTURES, LLC
Entity type:Organization
Organization Name:FR5 VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:ROTHACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-792-0008
Mailing Address - Street 1:20916 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-1643
Mailing Address - Country:US
Mailing Address - Phone:801-792-0008
Mailing Address - Fax:
Practice Address - Street 1:20916 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-1643
Practice Address - Country:US
Practice Address - Phone:801-792-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care