Provider Demographics
NPI:1609398767
Name:INSPIRA PSYCHIATRIC SERVICES PSC
Entity Type:Organization
Organization Name:INSPIRA PSYCHIATRIC SERVICES PSC
Other - Org Name:INSPIRA CLINIC PSG YAUCO
Other - Org Type:Other Name
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-704-0705
Mailing Address - Street 1:PO BOX 9809
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9809
Mailing Address - Country:US
Mailing Address - Phone:787-704-0705
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3531
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPIRA PSYCHIATRIC SERVICES PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder