Provider Demographics
NPI:1336465897
Name:RISING PHOENIX PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:RISING PHOENIX PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-209-0060
Mailing Address - Street 1:PO BOX 61232
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27661-1232
Mailing Address - Country:US
Mailing Address - Phone:919-209-0060
Mailing Address - Fax:
Practice Address - Street 1:101-1 N. 4TH STREET
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3941
Practice Address - Country:US
Practice Address - Phone:919-209-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health