Healthcare Provider Details

I. General information

NPI: 1699153213
Provider Name (Legal Business Name): INSPIRED INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8704 STATE ST
EAST SAINT LOUIS IL
62203-2048
US

IV. Provider business mailing address

8704 STATE ST
EAST SAINT LOUIS IL
62203-2048
US

V. Phone/Fax

Practice location:
  • Phone: 618-207-3479
  • Fax: 618-216-1172
Mailing address:
  • Phone: 618-207-3479
  • Fax: 618-216-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberA4215-0001-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberA4215-0001-A
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA4215-0001-A
License Number StateIL

VIII. Authorized Official

Name: GINA L WALKER
Title or Position: CEO/FOUNDER
Credential:
Phone: 618-207-3479