Provider Demographics
NPI:1114265691
Name:IASPIRE LLC
Entity Type:Organization
Organization Name:IASPIRE LLC
Other - Org Name:IASPIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-243-0020
Mailing Address - Street 1:3721 STATON DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-5051
Mailing Address - Country:US
Mailing Address - Phone:405-243-0020
Mailing Address - Fax:405-652-0305
Practice Address - Street 1:3721 STATON DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-5051
Practice Address - Country:US
Practice Address - Phone:405-243-0020
Practice Address - Fax:405-652-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200491540AMedicaid