1679075212 NPI number — INSPIRA BEHAVIORAL CARE CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679075212 NPI number — INSPIRA BEHAVIORAL CARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSPIRA BEHAVIORAL CARE CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INSPIRA AMBULATORY CLINIC - COAMO
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679075212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9809
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-9809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-704-0705
Provider Business Mailing Address Fax Number:
787-744-7444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COAMO PLAZA SHOPPING CENTER
Provider Second Line Business Practice Location Address:
CARR 153 KM 13.3
Provider Business Practice Location Address City Name:
COAMO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-704-0705
Provider Business Practice Location Address Fax Number:
787-744-7444
Provider Enumeration Date:
02/28/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
ENRIQUE
Authorized Official Title or Position:
CONTRACTING DIRECTOR
Authorized Official Telephone Number:
787-704-0705

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: CASM-0779 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)