Provider Demographics
NPI:1174875736
Name:FOOTPRINTS CASE MANAGEMENT
Entity type:Organization
Organization Name:FOOTPRINTS CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:704-412-2144
Mailing Address - Street 1:PO BOX 1425
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-1425
Mailing Address - Country:US
Mailing Address - Phone:704-412-2144
Mailing Address - Fax:704-353-7315
Practice Address - Street 1:715 NARAMORE ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-6921
Practice Address - Country:US
Practice Address - Phone:704-412-2144
Practice Address - Fax:704-353-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-07
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC212631251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management