Healthcare Provider Details

I. General information

NPI: 1437994944
Provider Name (Legal Business Name): INSPIRE TOGETHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S VERMONT AVE
LOS ANGELES CA
90037-3529
US

IV. Provider business mailing address

737 W 31ST ST # A
SAN PEDRO CA
90731-6726
US

V. Phone/Fax

Practice location:
  • Phone: 760-905-0307
  • Fax:
Mailing address:
  • Phone: 760-905-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASMOND NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-905-0307