Provider Demographics
NPI:1376261446
Name:RISING SWELL MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:RISING SWELL MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDLAK
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:732-784-8272
Mailing Address - Street 1:23 BRISCOE TER
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1127
Mailing Address - Country:US
Mailing Address - Phone:732-784-8272
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD STE 69
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1668
Practice Address - Country:US
Practice Address - Phone:732-784-8272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty