Healthcare Provider Details

I. General information

NPI: 1780214312
Provider Name (Legal Business Name): FOOTHILLS GATEWAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SKYWAY DR
FORT COLLINS CO
80525-3911
US

IV. Provider business mailing address

301 SKYWAY DR
FORT COLLINS CO
80525-3911
US

V. Phone/Fax

Practice location:
  • Phone: 970-690-8126
  • Fax:
Mailing address:
  • Phone: 970-690-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CARLA CONRARDY
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 970-266-5444