MEDICARE: INSPIRE ADVOCACY SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1720732670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRE ADVOCACY SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	16017 JOHNS LAKE RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-9013
Country	:	US
Telephone Number	:	352-978-5554
Fax Number	:	352-702-6382

Provider Business Practice Location Address
First Line	:	16017 JOHNS LAKE RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-9013
Country	:	US
Telephone Number	:	352-978-5554
Fax Number	:	352-702-6382

Authorized Official
Title or Position	:	OWNER
Name	:	KATREENA MALIK
Credential	:
Telephone Number	:	352-978-5554

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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