Basic Information
| Provider Information | |||||||||
| NPI: | 1821033903 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASPIRE HEALTH PARTNERS, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | LAKESIDE BEHAVIORAL HEALTHCARE, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 ADANSON ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328041330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078753700 | ||||||||
| FaxNumber: | 4076231037 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MERCY DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328085646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078753700 | ||||||||
| FaxNumber: | 4075224671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DAMM | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4078753700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 283Q00000X | N | Hospitals | Psychiatric Hospital | 261QM0801X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 011030401 | 05 | FL | MEDICAID | 012380700 | 05 | FL | MEDICAID | 060379100 | 05 | FL | MEDICAID | 011030400 | 05 | FL | MEDICAID | 060379105 | 05 | FL | MEDICAID | 060379106 | 05 | FL | MEDICAID | 011837700 | 05 | FL | MEDICAID | 011116800 | 05 | FL | MEDICAID | 012188900 | 05 | FL | MEDICAID | 108981200 | 05 | FL | MEDICAID | 011168001 | 05 | FL | MEDICAID | 060379101 | 05 | FL | MEDICAID | 060379116 | 05 | FL | MEDICAID | 011168002 | 05 | FL | MEDICAID | 763232100 | 05 | FL | MEDICAID |