Provider Demographics
NPI:1679092985
Name:FOOTPRINTS HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:FOOTPRINTS HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKELEFAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-579-6648
Mailing Address - Street 1:35324 SR 54
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1942
Mailing Address - Country:US
Mailing Address - Phone:813-395-5269
Mailing Address - Fax:
Practice Address - Street 1:2310 WHITEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5061
Practice Address - Country:US
Practice Address - Phone:813-345-7067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679403Medicaid
FLPENDINGOtherAHCA
FL11920OtherAHCA