Healthcare Provider Details

I. General information

NPI: 1952382525
Provider Name (Legal Business Name): FOOTHILL CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 W SOUTHERN AVE
APACHE JUNCTION AZ
85220-7305
US

IV. Provider business mailing address

2012 W SOUTHERN AVE
APACHE JUNCTION AZ
85220-7305
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0700
  • Fax: 480-983-7318
Mailing address:
  • Phone: 480-983-0700
  • Fax: 480-983-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-363
License Number StateAZ

VIII. Authorized Official

Name: MR. GEORGE F JACOBSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-983-0700