Provider Demographics
NPI:1093838237
Name:FOOTPRINTS CAROLINA INC
Entity Type:Organization
Organization Name:FOOTPRINTS CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QAQI MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:STRICKLAND
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-524-2009
Mailing Address - Street 1:2020 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7437
Mailing Address - Country:US
Mailing Address - Phone:704-524-2009
Mailing Address - Fax:704-524-2095
Practice Address - Street 1:970 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5804
Practice Address - Country:US
Practice Address - Phone:704-854-4826
Practice Address - Fax:704-524-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness