=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548084635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRA BEHAVIORAL CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2024
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 EDF. A. PORRATA PILA 2431 BLVD. LUIS A. FERRE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
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 | PROVIDERS DEPARTMENT
-----------------------------------------------------
Name | PAMELA MARTINEZ
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
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 |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------