Basic Information
Provider Information | |||||||||
NPI: | 1760983399 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | INSPIRA BEHAVIORAL CARE CORP. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | INSPIRA AMBULATORY CLINIC - CAROLINA | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9809 | ||||||||
Address2: |   | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 007269809 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877040705 | ||||||||
FaxNumber: | 7877447444 | ||||||||
Practice Location | |||||||||
Address1: | 23 CAROLINA CENTURY BUSINESS CENTER | ||||||||
Address2: | CARR 848 | ||||||||
City: | CAROLINA | ||||||||
State: | PR | ||||||||
PostalCode: | 00985 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877040705 | ||||||||
FaxNumber: | 7877447444 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/28/2018 | ||||||||
LastUpdateDate: | 02/28/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TORRES | ||||||||
AuthorizedOfficialFirstName: | JAVIER | ||||||||
AuthorizedOfficialMiddleName: | ENRIQUE | ||||||||
AuthorizedOfficialTitleorPosition: | CONTRACTING DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7877040705 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MHSA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | CASM-0781 | PR | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.