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General NPI Number Information
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NPI Number | 1336583178
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Entity Type | Organization
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Legal Business Name | FOOT PRINT TO SUCCESS CLUBHOUSE INC.
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 3511 NW 8TH AVE STE 7
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3055
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Country | US
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Telephone | 954-657-8010
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Fax | 954-657-8046
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Provider Business Mailing Address
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Address Line | 3511 NW 8TH AVE STE 7
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3055
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Country | US
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Telephone | 954-657-8010
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Fax | 954-657-8046
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | MRS. BARBARA JANE HARMON
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Credential | RN
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Telephone | 954-657-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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