Healthcare Provider Details

I. General information

NPI: 1912377599
Provider Name (Legal Business Name): FOOTSTOOL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S PARKER RD BUILDING 1-118
AURORA CO
80014
US

IV. Provider business mailing address

2600 S PARKER RD BUILDING 1-118
AURORA CO
80014
US

V. Phone/Fax

Practice location:
  • Phone: 720-253-0647
  • Fax:
Mailing address:
  • Phone: 720-253-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04Q653
License Number StateCO

VIII. Authorized Official

Name: JUDE L GANGDIA
Title or Position: CO-OWNER
Credential:
Phone: 720-275-8253