Organization
FOOTPRINTS CAROLINA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD ANDERSON BS (CEO)
(704) 884-2500
Entity
Organization
Contact information
Practice address
917 FIRST STREET, SHELBY, NC 28150-3958
(704) 480-6641
(704) 480-1364
Mailing address
2020 REMOUNT RD, GASTONIA, NC 28054-7476
(704) 884-2500
(704) 524-2095
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906002
—
NC
05
—
6005633
—
NC
05
—
8300451
—
NC
05
—
8300451B
—
NC
05
—
8300451G
—
NC
05
—
8300451H
—
NC
Enumeration date
11/30/2007
Last updated
12/03/2007
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