Provider Demographics
NPI:1750510012
Name:ASPIRE INDIANA INC
Entity Type:Organization
Organization Name:ASPIRE INDIANA INC
Other - Org Name:BEHAVIORCORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-587-0505
Mailing Address - Street 1:9615 E 148TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-587-0500
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:9615 E 148TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4371
Practice Address - Country:US
Practice Address - Phone:317-587-0500
Practice Address - Fax:317-674-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN430-0-CMHC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN945920Medicare PIN