Basic Information
| Provider Information | |||||||||
| NPI: | 1073015566 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INSPIRA BEHAVIORAL CARE CORP. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | INSPIRA AMBULATORY CLINIC - LOIZA/RIO GRANDE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9809 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007269809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877447444 | ||||||||
| Practice Location | |||||||||
| Address1: | INDUSTRIAL PARK LAS FLORES | ||||||||
| Address2: | CARR 3 KM 23.9 | ||||||||
| City: | RIO GRANDE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877447444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2018 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TORRES | ||||||||
| AuthorizedOfficialFirstName: | JAVIER | ||||||||
| AuthorizedOfficialMiddleName: | ENRIQUE | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7877040705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MHSA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | CASM-0780 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.