=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184787806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOTHILLS HOME CARE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 N WASHINGTON ST
-----------------------------------------------------
City | RUTHERFORDTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28139-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-288-7175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 N WASHINGTON ST
-----------------------------------------------------
City | RUTHERFORDTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28139-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-288-7175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY DIRECTOR
-----------------------------------------------------
Name | MRS. SYLVIA J WHITENER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 828-288-7175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 251E00000X
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------