Provider Demographics
NPI:1053682435
Name:FOOTPRINTS IN RECOVERY LLC
Entity Type:Organization
Organization Name:FOOTPRINTS IN RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KOZER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN
Authorized Official - Phone:877-429-0713
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948
Mailing Address - Country:US
Mailing Address - Phone:877-429-0713
Mailing Address - Fax:252-441-8248
Practice Address - Street 1:4721 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-8912
Practice Address - Country:US
Practice Address - Phone:877-429-0713
Practice Address - Fax:252-441-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility