=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942962337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRE GREATNESS WITHIN, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2021
-----------------------------------------------------
Last Update Date | 10/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 446 S HARPER AVE
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60425-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-660-6374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 837 RIVERVIEW DR
-----------------------------------------------------
City | SOUTH HOLLAND
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60473-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-563-7568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JAMES MARSHALL
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 773-563-7568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------