MEDICARE: ENSPIRIT HEALTHCARE LLC

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	:	1235877598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSPIRIT HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	11330 VANSTORY DR STE 114F
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-8146
Country	:	US
Telephone Number	:	704-897-2584
Fax Number	:

Provider Business Practice Location Address
First Line	:	11330 VANSTORY DR STE 114F
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-8146
Country	:	US
Telephone Number	:	704-897-2584
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRADFORD JOHN CARY-COLEMAN
Credential	:
Telephone Number	:	336-340-5138

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/26/2022

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Directions to “ENSPIRIT HEALTHCARE LLC ” Practice Location

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