MEDICARE: INSPIRE COMMUNITY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1043522303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRE COMMUNITY SERVICES INC

Provider Business Mailing Address
First Line	:	3713 STILLWOOD DR
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-9063
Country	:	US
Telephone Number	:	252-714-8788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2523 DRUID OAKS NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3295
Country	:	US
Telephone Number	:	252-714-8788
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GROVER LEE BENTON JR.
Credential	:
Telephone Number	:	252-714-8788

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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