Provider Demographics
NPI:1083169213
Name:FOOTHILLS COMMUNITY HEALTH CARE
Entity Type:Organization
Organization Name:FOOTHILLS COMMUNITY HEALTH CARE
Other - Org Name:FOOTHILLS COMMUNITY HEALTH CARE EASLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RAJKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-722-0283
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-0311
Mailing Address - Country:US
Mailing Address - Phone:864-722-0283
Mailing Address - Fax:
Practice Address - Street 1:403 HILLCREST DR STE E
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1207
Practice Address - Country:US
Practice Address - Phone:864-722-0283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)