Healthcare Provider Details

I. General information

NPI: 1043507320
Provider Name (Legal Business Name): FOOTPRINTS MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SIERRA DRIVE SE, SUITE 4
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

PO BOX 26871
ALBUQUERQUE NM
87125-6871
US

V. Phone/Fax

Practice location:
  • Phone: 505-331-0223
  • Fax:
Mailing address:
  • Phone: 505-331-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. THERESA L WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential: BBA
Phone: 505-331-0223