Provider Demographics
NPI:1194142067
Name:FOOTPRINTS HAMILTON OPERATIONS LLC
Entity type:Organization
Organization Name:FOOTPRINTS HAMILTON OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIRSCH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:609-249-4645
Mailing Address - Street 1:3635 QUAKERBRIDGE ROAD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-249-4645
Mailing Address - Fax:
Practice Address - Street 1:3635 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 18
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1247
Practice Address - Country:US
Practice Address - Phone:609-249-4645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000585324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility