Provider Demographics
NPI:1609349430
Name:ASPIRED RESIDENTIAL REHABILITATION GROUP
Entity Type:Organization
Organization Name:ASPIRED RESIDENTIAL REHABILITATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERVONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-221-1140
Mailing Address - Street 1:13906 BALLANTYNE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3727
Mailing Address - Country:US
Mailing Address - Phone:984-221-1140
Mailing Address - Fax:
Practice Address - Street 1:1714 ASTER LN
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-8303
Practice Address - Country:US
Practice Address - Phone:984-221-1140
Practice Address - Fax:803-630-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children