Provider Demographics
NPI:1932114410
Name:FIRESPIRIT INC
Entity Type:Organization
Organization Name:FIRESPIRIT INC
Other - Org Name:FIRESPIRIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-898-9942
Mailing Address - Street 1:6612 TERRA DOLCE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1365
Mailing Address - Country:US
Mailing Address - Phone:505-898-9942
Mailing Address - Fax:505-898-7176
Practice Address - Street 1:6612 TERRA DOLCE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1365
Practice Address - Country:US
Practice Address - Phone:505-898-9942
Practice Address - Fax:505-898-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-062501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34070575Medicaid
NM300522272Medicare ID - Type Unspecified