Healthcare Provider Details

I. General information

NPI: 1194318097
Provider Name (Legal Business Name): ASPIRE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 N 59TH AVE
GLENDALE AZ
85302-5433
US

IV. Provider business mailing address

8607 N 59TH AVE
GLENDALE AZ
85302-5433
US

V. Phone/Fax

Practice location:
  • Phone: 619-817-1936
  • Fax:
Mailing address:
  • Phone: 619-817-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOHAMED MOHAMUD MOHAMED
Title or Position: CEO
Credential:
Phone: 619-817-1936