Healthcare Provider Details

I. General information

NPI: 1134899123
Provider Name (Legal Business Name): FOOTHILL HOUSE OF HOSPITALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 SUTTON WAY # A
GRASS VALLEY CA
95945-5175
US

IV. Provider business mailing address

1262 SUTTON WAY # A
GRASS VALLEY CA
95945-5175
US

V. Phone/Fax

Practice location:
  • Phone: 530-401-2162
  • Fax:
Mailing address:
  • Phone: 916-335-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY SIERRA BAGLIETTO
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 530-615-0807