Healthcare Provider Details

I. General information

NPI: 1679056857
Provider Name (Legal Business Name): INSPIRE TO RISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5927 OLD TIMUQUANA RD
JACKSONVILLE FL
32210
US

IV. Provider business mailing address

5927 OLD TIMUQUANA RD
JACKSONVILLE FL
32210-7889
US

V. Phone/Fax

Practice location:
  • Phone: 844-937-4731
  • Fax: 904-490-8394
Mailing address:
  • Phone: 844-937-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AIDA PANTALEON SEERAJ
Title or Position: CEO/OWNER
Credential:
Phone: 844-937-4731