# INSPIRE TO RISE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679056857
- **Authorized official:** MRS. AIDA PANTALEON SEERAJ (CEO/OWNER)
- **Authorized official phone:** (844) 937-4731

## Contact information

- **Practice address:** 5927 OLD TIMUQUANA RD, JACKSONVILLE, FL 32210
- **Practice address phone:** (844) 937-4731
- **Practice address fax:** (904) 490-8394
- **Mailing address:** 5927 OLD TIMUQUANA RD, JACKSONVILLE, FL 32210-7889
- **Mailing address phone:** (844) 937-4731

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/13/2018
- **Last updated:** 09/04/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 101215400 | — | FL |
| 01 | — | LIC-1047530 | DCF SAMH LICENSE FOR CASE MANAGEMENT | FL |
| 01 | — | LIC-1047531 | DCF SAMH LICENSE FOR OUTPATIENT TREATMENT | FL |
| 01 | — | LIC-1047532 | DCF SAMH LICENSE FOR GENERAL INTERVENTION | FL |