NPIMap

Organization Active NPI

Foothills Academy, Inc.

Doing business as Community Based Interventions

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Monticello, KY
National Provider Identifier
1114291879
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
500595 Issued in KY
Legal business name
FOOTHILLS ACADEMY, INC.
Doing business as
Community Based Interventions
Otter Creek
Practice address
80 Rolling Hills Blvd
Monticello, KY 42633-9005
Phone
(606) 343-0216
Fax
(606) 343-0224
NPI assigned
Feb 28, 2012
Last updated
May 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samantha Ann Simmons, LPCC, LCADCNPI 1629123625
Title
Director
Phone
(606) 343-0216

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Multi-Specialty Clinic/Center 261QM1300X NU
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 500595 KY Primary
Children's Substance Abuse Rehabilitation Facility 3245S0500X 500595 KY

Addresses

Primary practice location

80 Rolling Hills Blvd
Monticello, KY 42633-9005

Mailing address

80 Rolling Hills Blvd
Monticello, KY 42633-9005
Phone (606) 343-0216

Other practice location 1

132 Foothills Ave
Albany, KY 42602-1090
Phone (606) 387-0567

Other identifiers 1

IdentifierTypeStateIssuer
7100317630MedicaidKY

Other names 2

  • Community Based Interventions Doing business as
  • Otter Creek Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181004002039 KY Part B Supplier - Clinic/Group Practice 5698027563 Receives reassigned benefits from 8 practitioners
Practice locations: Monticello, KY; Albany, KY

National Provider Directory

National Provider Directory
Tax ID family
Foothills Academy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

104 N Washington St
Albany, KY 42602
Phone (606) 387-0567

107 Foothills Academy Spur
Albany, KY 42602
Phone (606) 387-4673

132 Foothills Ave
Albany, KY 42602
Phone (606) 387-0567

157 N Main St
Monticello, KY 42633
Phone (606) 343-0203

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1114291879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 ROLLING HILLS BLVD",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426339005",
            "telephone_number": "606-343-0216",
            "fax_number": "606-343-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 ROLLING HILLS BLVD",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426339005",
            "telephone_number": "606-343-0216",
            "fax_number": "606-343-0224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "132 Foothills Ave",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "KY",
            "postal_code": "426021090",
            "country_code": "US",
            "telephone_number": "606-387-0567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOOTHILLS ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-28",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "606-343-0216",
        "authorized_official_credential": "LPCC, LCADC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "KY",
            "license": "500595",
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "KY",
            "license": "500595",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100317630",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Based Interventions",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Based Interventions",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Otter Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.