Provider Demographics
NPI:1659608123
Name:INSPIRATIONS GROUP HOME, LLC
Entity Type:Organization
Organization Name:INSPIRATIONS GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-794-7695
Mailing Address - Street 1:7113 S 7TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6766
Mailing Address - Country:US
Mailing Address - Phone:602-323-2601
Mailing Address - Fax:602-476-6980
Practice Address - Street 1:7113 S 7TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6766
Practice Address - Country:US
Practice Address - Phone:602-323-2601
Practice Address - Fax:602-476-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ445542320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ445542OtherSTATE OF ARIZONA DIVISION OF DEVELOPMENTAL DISABILITIES / AHCCCS