Provider Demographics
NPI:1073015566
Name:INSPIRA BEHAVIORAL CARE CORP.
Entity Type:Organization
Organization Name:INSPIRA BEHAVIORAL CARE CORP.
Other - Org Name:INSPIRA AMBULATORY CLINIC - LOIZA/RIO GRANDE
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTRACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-704-0705
Mailing Address - Street 1:PO BOX 9809
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9809
Mailing Address - Country:US
Mailing Address - Phone:787-704-0705
Mailing Address - Fax:787-744-7444
Practice Address - Street 1:INDUSTRIAL PARK LAS FLORES
Practice Address - Street 2:CARR 3 KM 23.9
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:787-744-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
PRCASM-0780261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)