Provider Demographics
NPI:1780368514
Name:ASPIRE BEHAVORIAL HEALTH LLC
Entity type:Organization
Organization Name:ASPIRE BEHAVORIAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-351-7998
Mailing Address - Street 1:515 REDONDO AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-5131
Mailing Address - Country:US
Mailing Address - Phone:702-351-7998
Mailing Address - Fax:
Practice Address - Street 1:515 REDONDO AVE STE C1
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-5131
Practice Address - Country:US
Practice Address - Phone:702-351-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)