Healthcare Provider Details

I. General information

NPI: 1467742650
Provider Name (Legal Business Name): INSPIRA BEHAVIORAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 04/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 CALLE GUADALUPE
PONCE PR
00730-3561
US

IV. Provider business mailing address

PO BOX 122
COAMO PR
00769-0122
US

V. Phone/Fax

Practice location:
  • Phone: 787-709-4134
  • Fax:
Mailing address:
  • Phone: 787-595-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number10397
License Number StatePR

VIII. Authorized Official

Name: MISS ALVARADO AIMEE MARTINEZ
Title or Position: CLINIC SOCIAL WORKER
Credential: MSW
Phone: 787-595-0348