Healthcare Provider Details

I. General information

NPI: 1528921921
Provider Name (Legal Business Name): ASPIRE HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 QUINCY AVE
QUINCY MA
02169-8130
US

IV. Provider business mailing address

220 BEDFORD ST BRIDGEWATER H10
BRIDGEWATER MA
02324-3146
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1950
  • Fax:
Mailing address:
  • Phone: 508-631-7468
  • Fax: 508-631-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ISSIAH CHARLES DONAHUE-VIL
Title or Position: MENTAL HEALTH WORKER
Credential:
Phone: 508-631-7468