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General NPI Number Information
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NPI Number | 1821595281
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Entity Type | Organization
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Legal Business Name | INSPIRATIONS YOUTH ACADEMY LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 757 SOUTH EAST 17TH STREET
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2960
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Country | US
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Telephone | 800-868-8772
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Fax |
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Provider Business Mailing Address
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Address Line | 757 SOUTH EAST 17TH STREET
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2960
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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 | OWNER/PRESIDENT
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Name | CHRIS WALSH
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Credential | LPN
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Telephone | 954-376-4783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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