Provider Demographics
NPI:1336583178
Name:FOOT PRINT TO SUCCESS CLUBHOUSE INC.
Entity Type:Organization
Organization Name:FOOT PRINT TO SUCCESS CLUBHOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-657-8010
Mailing Address - Street 1:3511 NW 8TH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3055
Mailing Address - Country:US
Mailing Address - Phone:954-657-8010
Mailing Address - Fax:954-657-8046
Practice Address - Street 1:3511 NW 8TH AVE STE 7
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3055
Practice Address - Country:US
Practice Address - Phone:954-657-8010
Practice Address - Fax:954-657-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage