Provider Demographics
NPI:1114498813
Name:FOOTPRINTS ELGIN IL LLC
Entity Type:Organization
Organization Name:FOOTPRINTS ELGIN IL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABANAGIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-810-3540
Mailing Address - Street 1:PO BOX 779101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-9101
Mailing Address - Country:US
Mailing Address - Phone:872-810-3540
Mailing Address - Fax:732-360-6394
Practice Address - Street 1:411 W RIVER RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1570
Practice Address - Country:US
Practice Address - Phone:224-523-2581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)