Provider Demographics
NPI:1336652122
Name:RISING ROADS RECOVERY SERVICES FOR WOMEN, LLC
Entity Type:Organization
Organization Name:RISING ROADS RECOVERY SERVICES FOR WOMEN, LLC
Other - Org Name:RISING ROADS RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GATDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-673-9007
Mailing Address - Street 1:3151 AIRWAY AVE STE I3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4624
Mailing Address - Country:US
Mailing Address - Phone:949-922-1901
Mailing Address - Fax:
Practice Address - Street 1:10605 EL ESTE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6009
Practice Address - Country:US
Practice Address - Phone:949-922-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300659AP324500000X
CA300659BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300659DPOtherSUBSTANCE ABUSE OP SERVICES
CA300659APOtherSUBSTANCE ABUSE REHAB
CA300659BPOtherSUBSTANCE ABUSE REHAB