Healthcare Provider Details

I. General information

NPI: 1114291879
Provider Name (Legal Business Name): FOOTHILLS ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ROLLING HILLS BLVD
MONTICELLO KY
42633-9005
US

IV. Provider business mailing address

80 ROLLING HILLS BLVD
MONTICELLO KY
42633-9005
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 Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number500595
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number500595
License Number StateKY

VIII. Authorized Official

Name: SAMANTHA ANN SIMMONS
Title or Position: DIRECTOR
Credential: LPCC, LCADC
Phone: 606-343-0216