Provider Demographics
NPI:1235877598
Name:ENSPIRIT HEALTHCARE LLC
Entity Type:Organization
Organization Name:ENSPIRIT HEALTHCARE LLC
Other - Org Name:PROGRESSIVE SPECTRUM LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARY-COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-340-5138
Mailing Address - Street 1:11330 VANSTORY DR STE 114F
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8146
Mailing Address - Country:US
Mailing Address - Phone:704-897-2584
Mailing Address - Fax:
Practice Address - Street 1:11330 VANSTORY DR STE 114F
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8146
Practice Address - Country:US
Practice Address - Phone:704-897-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health