Provider Demographics
NPI:1376015206
Name:SPIRE HEALTH, LLC
Entity Type:Organization
Organization Name:SPIRE HEALTH, LLC
Other - Org Name:MODYFI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:240-771-5793
Mailing Address - Street 1:3202 ANCOATS ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8199
Mailing Address - Country:US
Mailing Address - Phone:240-771-5793
Mailing Address - Fax:470-867-2636
Practice Address - Street 1:1125 WEST ST STE 316
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4198
Practice Address - Country:US
Practice Address - Phone:240-771-5793
Practice Address - Fax:470-867-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)