Provider Demographics
NPI:1275992588
Name:INSPIRE TARGETED CASE MANAGEMENT AGENCY LLC
Entity type:Organization
Organization Name:INSPIRE TARGETED CASE MANAGEMENT AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:VIOLET
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-535-3857
Mailing Address - Street 1:579 FINCH CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759
Mailing Address - Country:US
Mailing Address - Phone:863-272-1933
Mailing Address - Fax:
Practice Address - Street 1:929 GILMORE AVE
Practice Address - Street 2:APT. 76
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:863-272-1933
Practice Address - Fax:239-302-1344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPIRE TARGETED CASE MANAGEMENT AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-15
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1457719742Medicaid