Provider Demographics
NPI:1114291879
Name:FOOTHILLS ACADEMY, INC.
Entity Type:Organization
Organization Name:FOOTHILLS ACADEMY, INC.
Other - Org Name:COMMUNITY BASED INTERVENTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LCADC
Authorized Official - Phone:606-343-0216
Mailing Address - Street 1:80 ROLLING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9005
Mailing Address - Country:US
Mailing Address - Phone:606-343-0216
Mailing Address - Fax:606-343-0224
Practice Address - Street 1:80 ROLLING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9005
Practice Address - Country:US
Practice Address - Phone:606-343-0216
Practice Address - Fax:606-343-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QM0801X, 261QM1300X
KY500595322D00000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100317630Medicaid