Basic Information
Provider Information | |||||||||
NPI: | 1902362908 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | INSPIRA BEHAVIORAL CARE CORP. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
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: | 12 CALLE ROMAN BALDORIOTY DE CASTRO | ||||||||
Address2: |   | ||||||||
City: | CIDRA | ||||||||
State: | PR | ||||||||
PostalCode: | 00739 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877040705 | ||||||||
FaxNumber: | 7877447444 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/14/2019 | ||||||||
LastUpdateDate: | 02/14/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TORRES | ||||||||
AuthorizedOfficialFirstName: | JAVIER | ||||||||
AuthorizedOfficialMiddleName: | ENRIQUE | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7877040705 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | INSPIRA BEHAVIORAL CARE CORP. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
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) | 283Q00000X |   |   | Y |   | Hospitals | Psychiatric Hospital |   |
No ID Information.