Provider Demographics
NPI:1871672824
Name:FOOTHILLS INDUSTRIES OF MCDOWELL COUNTY, INC.
Entity Type:Organization
Organization Name:FOOTHILLS INDUSTRIES OF MCDOWELL COUNTY, INC.
Other - Org Name:FOOTHILLS INDUSTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-652-4088
Mailing Address - Street 1:300 ROCKWELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-9207
Mailing Address - Country:US
Mailing Address - Phone:828-652-4088
Mailing Address - Fax:828-652-7527
Practice Address - Street 1:300 ROCKWELL DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-9207
Practice Address - Country:US
Practice Address - Phone:828-652-4088
Practice Address - Fax:828-652-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-059-031251C00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408827Medicaid