Provider Demographics
NPI:1598161788
Name:INSPIRE YOUTH ACADEMY LLC
Entity Type:Organization
Organization Name:INSPIRE YOUTH ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-644-7753
Mailing Address - Street 1:24 SW 10TH ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1272
Mailing Address - Country:US
Mailing Address - Phone:813-644-7753
Mailing Address - Fax:888-482-2405
Practice Address - Street 1:757 SE 17TH ST
Practice Address - Street 2:#328
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2960
Practice Address - Country:US
Practice Address - Phone:813-644-7753
Practice Address - Fax:888-482-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children