Healthcare Provider Details

I. General information

NPI: 1528108271
Provider Name (Legal Business Name): FOOTPRINTS HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941-A JEFFERSON ST NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

5941-A JEFFERSON ST NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-4100
  • Fax: 505-889-9400
Mailing address:
  • Phone: 505-883-4100
  • Fax: 505-889-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number6214
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6214
License Number StateNM

VIII. Authorized Official

Name: MR. BRIAN FLETCHER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 505-503-2742