Provider Demographics
NPI:1760737621
Name:FOOTPRINTS ADULT DAY SERVICES
Entity Type:Organization
Organization Name:FOOTPRINTS ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-683-4201
Mailing Address - Street 1:701 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-2361
Mailing Address - Country:US
Mailing Address - Phone:601-683-4200
Mailing Address - Fax:
Practice Address - Street 1:851 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-2384
Practice Address - Country:US
Practice Address - Phone:601-683-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MISSISSIPPI RESIDENTIAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCMRC-BCS-ALZD-01261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care