Provider Demographics
NPI:1407407166
Name:INSPIRING CHANGE TREATMENT AND RECOVERY
Entity Type:Organization
Organization Name:INSPIRING CHANGE TREATMENT AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:POLITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-816-0343
Mailing Address - Street 1:42080 W SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3277
Mailing Address - Country:US
Mailing Address - Phone:336-816-0343
Mailing Address - Fax:
Practice Address - Street 1:1785 E SAHARA AVE STE 255
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3716
Practice Address - Country:US
Practice Address - Phone:336-816-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health