Healthcare Provider Details

I. General information

NPI: 1679092985
Provider Name (Legal Business Name): FOOTPRINTS HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 WHITEWOOD AVE
SPRING HILL FL
34609-5061
US

IV. Provider business mailing address

35324 SR 54
ZEPHYRHILLS FL
33541-1942
US

V. Phone/Fax

Practice location:
  • Phone: 813-345-7067
  • Fax:
Mailing address:
  • Phone: 813-395-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: YVONNE LEKELEFAC
Title or Position: MEMBER
Credential:
Phone: 260-579-6648