Basic Information
| Provider Information | |||||||||
| NPI: | 1881344018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTHILL HOUSE OF HOSPITALITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1262 SUTTON WAY | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959455175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302717144 | ||||||||
| FaxNumber: | 5302059203 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959457891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302717144 | ||||||||
| FaxNumber: | 5302059203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | BAGLIETTO | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | SIERRA | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5306150807 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251X00000X | N | Agencies | Supports Brokerage | 302R00000X | N | Managed Care Organizations | Health Maintenance Organization | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 385H00000X | N | Respite Care Facility | Respite Care | 251B00000X | Y | Agencies | Case Management |
No ID Information.