Healthcare Provider Details

I. General information

NPI: 1366130460
Provider Name (Legal Business Name): ASPIRE COMMUNITY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 E MAIN ST
MESA AZ
85205-8022
US

IV. Provider business mailing address

5252 E MAIN ST
MESA AZ
85205-8022
US

V. Phone/Fax

Practice location:
  • Phone: 619-734-5891
  • Fax:
Mailing address:
  • Phone: 619-734-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ABDIRAHMAN DAHIR
Title or Position: CEO
Credential:
Phone: 619-734-5891