Healthcare Provider Details

I. General information

NPI: 1235877598
Provider Name (Legal Business Name): ENSPIRIT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11330 VANSTORY DR STE 114F
HUNTERSVILLE NC
28078-8146
US

IV. Provider business mailing address

11330 VANSTORY DR STE 114F
HUNTERSVILLE NC
28078-8146
US

V. Phone/Fax

Practice location:
  • Phone: 704-897-2584
  • Fax:
Mailing address:
  • Phone: 704-897-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRADFORD JOHN CARY-COLEMAN
Title or Position: CEO
Credential:
Phone: 336-340-5138