Healthcare Provider Details

I. General information

NPI: 1720684996
Provider Name (Legal Business Name): FOOTHILLS GATEWAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WOOD ST
FORT COLLINS CO
80521-1951
US

IV. Provider business mailing address

301 SKYWAY DR
FORT COLLINS CO
80525-3911
US

V. Phone/Fax

Practice location:
  • Phone: 970-266-5443
  • Fax:
Mailing address:
  • Phone: 970-266-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

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