Provider Demographics
NPI:1215328901
Name:USPIRITUS.INC
Entity type:Organization
Organization Name:USPIRITUS.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REGULATORY AFFAIRS & QI
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-515-0430
Mailing Address - Street 1:3121 BROOKLAWN CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1282
Mailing Address - Country:US
Mailing Address - Phone:502-451-5177
Mailing Address - Fax:502-451-0896
Practice Address - Street 1:3121 BROOKLAWN CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1282
Practice Address - Country:US
Practice Address - Phone:502-451-5177
Practice Address - Fax:502-451-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254670Medicaid
KY7100254680Medicaid
KY7100254620Medicaid
KY7100254660Medicaid
KY7100285130Medicaid
KY7100254690Medicaid