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General NPI Number Information
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NPI Number | 1023530524
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Entity Type | Organization
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Legal Business Name | INSPIRE A YOUTH, INC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 08/10/2017
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Provider Practice Location Address
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Address Line | 6630 AVENIDA VALENCIA
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City | RIVERSIDE
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State | CA
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Zip | 92509-5625
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Country | US
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Telephone | 909-717-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 12909 BOSTON AVENUE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LATRESE NICHOLE ARMSTRONG
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Credential |
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Telephone | 909-717-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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