Provider Demographics
NPI:1205388824
Name:FOOTSTEPS TO FREEDOM HEALTH AND WELLNESS
Entity type:Organization
Organization Name:FOOTSTEPS TO FREEDOM HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-692-3676
Mailing Address - Street 1:242 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7636
Mailing Address - Country:US
Mailing Address - Phone:561-223-2145
Mailing Address - Fax:561-223-2974
Practice Address - Street 1:242 ROYAL PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7636
Practice Address - Country:US
Practice Address - Phone:561-223-2145
Practice Address - Fax:561-223-2974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOTSTEPS TO FREEDOM RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)