MEDICARE: FORE SAIL ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	04T700	CO

General Provider Information

NPI Number	:	1275084006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORE SAIL ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	2606 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3031
Country	:	US
Telephone Number	:	719-368-1695
Fax Number	:	719-218-9277

Provider Business Practice Location Address
First Line	:	2606 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3031
Country	:	US
Telephone Number	:	719-368-1695
Fax Number	:	719-218-9277

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	DAN P. RODA
Credential	:
Telephone Number	:	719-368-1695

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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