Healthcare Provider Details

I. General information

NPI: 1174071724
Provider Name (Legal Business Name): CHILL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 ROBERTSON ST
FORT COLLINS CO
80524-3926
US

IV. Provider business mailing address

1021 ROBERTSON ST
FORT COLLINS CO
80524-3926
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-8572
  • Fax:
Mailing address:
  • Phone: 970-310-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA SNOWDON
Title or Position: OWNER/DIRECTOR
Credential: MSW
Phone: 970-310-8572