Basic Information
| Provider Information | |||||||||
| NPI: | 1093838237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTPRINTS CAROLINA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 REMOUNT RD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280547437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045242009 | ||||||||
| FaxNumber: | 7045242095 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 ROBERTS DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280545804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048544826 | ||||||||
| FaxNumber: | 7045242095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | STRICKLAND | ||||||||
| AuthorizedOfficialTitleorPosition: | QAQI MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7045242009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.