Provider Demographics
NPI:1184787806
Name:FOOTHILLS HOME CARE,LLC
Entity type:Organization
Organization Name:FOOTHILLS HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITENER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-288-7175
Mailing Address - Street 1:235 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2405
Mailing Address - Country:US
Mailing Address - Phone:828-288-7175
Mailing Address - Fax:
Practice Address - Street 1:235 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2405
Practice Address - Country:US
Practice Address - Phone:828-288-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409578Medicaid
NC7100534Medicaid
NC6600894Medicaid