1447631676 NPI number — ASPIRE HEALTH, LLC

Table of content: (NPI 1447631676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447631676 NPI number — ASPIRE HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRE HEALTH, LLC
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:
Provider Other Organization Name Type Code:
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:
1447631676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2445 W SILVER SAGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085-5740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-847-8839
Provider Business Mailing Address Fax Number:
623-847-8838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11215 W NEVADA AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
YOUNGTOWN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85363-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-977-9657
Provider Business Practice Location Address Fax Number:
623-583-7432
Provider Enumeration Date:
06/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER/OWNER
Authorized Official Telephone Number:
623-847-8839

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 027318 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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