Provider Demographics
NPI:1417615220
Name:RISE AND RESTORE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:RISE AND RESTORE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FENCEROY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-656-1679
Mailing Address - Street 1:2314 WILLINGTON SHOALS PL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8513
Mailing Address - Country:US
Mailing Address - Phone:770-656-1679
Mailing Address - Fax:
Practice Address - Street 1:2314 WILLINGTON SHOALS PL SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8513
Practice Address - Country:US
Practice Address - Phone:770-656-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care