Provider Demographics
NPI:1952514986
Name:FOOTHILLS FAMILY CARE LLC
Entity Type:Organization
Organization Name:FOOTHILLS FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:DRAPACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-626-8859
Mailing Address - Street 1:780 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6268
Mailing Address - Country:US
Mailing Address - Phone:860-626-8859
Mailing Address - Fax:860-489-7250
Practice Address - Street 1:780 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6268
Practice Address - Country:US
Practice Address - Phone:860-626-8859
Practice Address - Fax:860-489-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044942261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51575ZMedicare ID - Type Unspecified
NYH30120Medicare UPIN