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General NPI Number Information
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NPI Number | 1275907222
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Entity Type | Organization
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Legal Business Name | FOOTHILLS ADULT CARE ENRICHMENT SERVICES
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 1732 W BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37801-5510
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Country | US
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Telephone | 865-980-8023
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 W BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37801-5510
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Country | US
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Telephone | 865-980-8023
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Fax |
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Authorized Official
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Title or Position | OWNER/ DIRECTORS
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Name | MRS. AUNDREA MARIE SCHOLEM
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Credential | LPN
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Telephone | 865-980-8023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 00D6T
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License Number State | TN
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