Provider Demographics
NPI:1124483441
Name:INSPIRATION FIELD
Entity type:Organization
Organization Name:INSPIRATION FIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-384-8741
Mailing Address - Street 1:612 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2535
Mailing Address - Country:US
Mailing Address - Phone:719-384-8741
Mailing Address - Fax:719-384-4278
Practice Address - Street 1:612 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2535
Practice Address - Country:US
Practice Address - Phone:719-384-8741
Practice Address - Fax:719-384-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05023L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09140054Medicaid
CO09145871Medicaid
CO09147653Medicaid