Provider Demographics
NPI:1205199213
Name:FOTI ENTERPRISES, LLC
Entity Type:Organization
Organization Name:FOTI ENTERPRISES, LLC
Other - Org Name:LIFEWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONYH
Authorized Official - Middle Name:FOTI
Authorized Official - Last Name:SKLAVOUNAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-807-6129
Mailing Address - Street 1:1639 SNEED RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-8105
Mailing Address - Country:US
Mailing Address - Phone:704-807-6129
Mailing Address - Fax:704-802-4213
Practice Address - Street 1:1639 SNEED RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-8105
Practice Address - Country:US
Practice Address - Phone:704-807-6129
Practice Address - Fax:704-802-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-023-181320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities