Healthcare Provider Details

I. General information

NPI: 1821723750
Provider Name (Legal Business Name): INSPIRE MENTAL HEALTH CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 S 104TH AVE STE 207
PALOS PARK IL
60464-1512
US

IV. Provider business mailing address

15520 113TH AVE
ORLAND PARK IL
60467-4492
US

V. Phone/Fax

Practice location:
  • Phone: 312-459-3099
  • Fax:
Mailing address:
  • Phone: 312-459-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GHADA SHARABATEE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 312-459-3099