Provider Demographics
NPI:1396072708
Name:FOOTPRINTS IN TIME
Entity type:Organization
Organization Name:FOOTPRINTS IN TIME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-920-7223
Mailing Address - Street 1:805 MITCHELL STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651
Mailing Address - Country:US
Mailing Address - Phone:231-920-7223
Mailing Address - Fax:
Practice Address - Street 1:805 MITCHELL ST.
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651
Practice Address - Country:US
Practice Address - Phone:231-920-7223
Practice Address - Fax:231-839-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable