Healthcare Provider Details

I. General information

NPI: 1295059780
Provider Name (Legal Business Name): PROFESSIONAL FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 47TH ST STE 200
BOULDER CO
80301-1817
US

IV. Provider business mailing address

8573 MONTE VISTA AVE
NIWOT CO
80503-7190
US

V. Phone/Fax

Practice location:
  • Phone: 720-562-4470
  • Fax: 720-864-2839
Mailing address:
  • Phone: 720-530-5492
  • Fax: 720-494-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERYL BELLINGER
Title or Position: PRESIDENT
Credential:
Phone: 720-530-5492