Provider Demographics
NPI:1679056857
Name:INSPIRE TO RISE, INC.
Entity Type:Organization
Organization Name:INSPIRE TO RISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:PANTALEON
Authorized Official - Last Name:SEERAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-937-4731
Mailing Address - Street 1:5927 OLD TIMUQUANA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7889
Mailing Address - Country:US
Mailing Address - Phone:844-937-4731
Mailing Address - Fax:
Practice Address - Street 1:5927 OLD TIMUQUANA RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:844-937-4731
Practice Address - Fax:904-490-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101215400Medicaid
FLLIC-1047530OtherDCF SAMH LICENSE FOR CASE MANAGEMENT
FLLIC-1047532OtherDCF SAMH LICENSE FOR GENERAL INTERVENTION
FLLIC-1047531OtherDCF SAMH LICENSE FOR OUTPATIENT TREATMENT