MEDICARE: FOOTHILL CARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NCI-363	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952382525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILL CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	2012 W SOUTHERN AVE
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85220-7305
Country	:	US
Telephone Number	:	480-983-0700
Fax Number	:	480-983-7318

Provider Business Practice Location Address
First Line	:	2012 W SOUTHERN AVE
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85220-7305
Country	:	US
Telephone Number	:	480-983-0700
Fax Number	:	480-983-7318

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GEORGE F JACOBSON
Credential	:
Telephone Number	:	480-983-0700

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/22/2020

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Directions to “FOOTHILL CARE CENTER, LLC ” Practice Location

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