Provider Demographics
NPI:1154097368
Name:RISE UP RECOVERY
Entity Type:Organization
Organization Name:RISE UP RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEG
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-829-9155
Mailing Address - Street 1:507 VERMILLION ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:507 VERMILLION ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1938
Practice Address - Country:US
Practice Address - Phone:612-306-8499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care