Organization
FOOTPRINTS HOME CARE, INC
Active
Other names
Cowan Clinic, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN FLETCHER (PRESIDENT AND CEO)
(505) 503-2742
Entity
Organization
Contact information
Practice address
5941-A JEFFERSON ST NE, ALBUQUERQUE, NM 87109
(505) 883-4100
(505) 889-9400
Mailing address
5941-A JEFFERSON ST NE, ALBUQUERQUE, NM 87109
(505) 883-4100
(505) 889-9400
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
6214
NM
251J00000X
Nursing Care Agency
6214
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96917
—
NM
05
—
D0289
—
NM
Enumeration date
02/08/2007
Last updated
06/23/2014
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