Provider Demographics
NPI:1891037735
Name:ASPIRE REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:ASPIRE REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-624-8181
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1500
Mailing Address - Country:US
Mailing Address - Phone:248-624-8181
Mailing Address - Fax:855-624-8161
Practice Address - Street 1:1000 JOHN R RD STE 211
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4317
Practice Address - Country:US
Practice Address - Phone:248-951-8180
Practice Address - Fax:855-624-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007332103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty