=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336616630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRA BEHAVIORAL CARE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2018
-----------------------------------------------------
Last Update Date | 07/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE WILLIAM FONT FINAL
-----------------------------------------------------
City | CULEBRA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-704-0705
-----------------------------------------------------
Fax | 787-744-7444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9809
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00726-9809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-704-0705
-----------------------------------------------------
Fax | 787-744-7444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER SUPERVISOR
-----------------------------------------------------
Name | ZENAIDA MILLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-704-0705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------