Provider Demographics
NPI:1275907222
Name:FOOTHILLS ADULT CARE ENRICHMENT SERVICES
Entity Type:Organization
Organization Name:FOOTHILLS ADULT CARE ENRICHMENT SERVICES
Other - Org Name:ADULT LIFE CENTERS AND INDEPENDENCE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUNDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHOLEM
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:865-980-8023
Mailing Address - Street 1:1732 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-5510
Mailing Address - Country:US
Mailing Address - Phone:865-980-8023
Mailing Address - Fax:
Practice Address - Street 1:1732 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5510
Practice Address - Country:US
Practice Address - Phone:865-980-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00D6T251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services