Healthcare Provider Details

I. General information

NPI: 1578396305
Provider Name (Legal Business Name): FOOTHILLS RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 FOOTHILLS ACADEMY RD
ALBANY KY
42602-8729
US

IV. Provider business mailing address

365 FOOTHILLS ACADEMY RD
ALBANY KY
42602-8729
US

V. Phone/Fax

Practice location:
  • Phone: 606-343-0216
  • Fax: 606-343-0224
Mailing address:
  • Phone: 606-343-0216
  • Fax: 606-343-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA SIMMONS
Title or Position: BOARD MEMBER
Credential: LPCC-S LCADC
Phone: 606-343-0216