# HERON LAKE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HERON LAKE LLC
- **Other names:** Foxtrail Family Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407012826
- **Legal business name:** HERON LAKE LLC
- **Authorized official:** STEPHANIE DOUGHTY (CFO)
- **Authorized official phone:** (970) 237-7003

## Contact information

- **Practice address:** 1625 FOXTRAIL DR, STE 190, LOVELAND, CO 80538-9088
- **Practice address phone:** (970) 619-6900
- **Practice address fax:** (970) 619-6990
- **Mailing address:** 2695 ROCKY MOUNTAIN AVE, STE 150, LOVELAND, CO 80538-8702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/05/2008
- **Last updated:** 01/14/2014