=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841932365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRE HEALTH PARTNERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2022
-----------------------------------------------------
Last Update Date | 09/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 W. MEMORIAL DRIVE
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-456-2010
-----------------------------------------------------
Fax | 912-456-2011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5151 ADANSON ST STE 201
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-875-3700
-----------------------------------------------------
Fax | 407-623-1037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LINDA M DAMM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-875-3700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------