NPIMap

Organization Active NPI

Footprints Carolina Inc

  • Case Management Agency
  • Shelby, NC
National Provider Identifier
1376725366
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
FOOTPRINTS CAROLINA INC
Practice address
917 First Street
Shelby, NC 28150-3958
Phone
(704) 480-6641
Fax
(704) 480-1364
NPI assigned
Nov 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Richard Anderson, BS
Title
Ceo
Phone
(704) 884-2500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

917 First Street
Shelby, NC 28150-3958

Mailing address

2020 Remount Rd
Gastonia, NC 28054-7476
Phone (704) 884-2500

Other identifiers 6

IdentifierTypeStateIssuer
6005633MedicaidNC
5906002MedicaidNC
8300451MedicaidNC
8300451BMedicaidNC
8300451GMedicaidNC
8300451HMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Footprints Carolina Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

917 1st St
Shelby, NC 28150
Phone (704) 476-4027

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1376725366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 REMOUNT RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547476",
            "telephone_number": "704-884-2500",
            "fax_number": "704-524-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 FIRST STREET",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503958",
            "telephone_number": "704-480-6641",
            "fax_number": "704-480-1364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTPRINTS CAROLINA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-884-2500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005633",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906002",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300451",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300451B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300451G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300451H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.