Provider Demographics
NPI:1437546991
Name:RISING UP FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:RISING UP FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MHP
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:VINCESON
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:SR
Authorized Official - Credentials:MHP
Authorized Official - Phone:318-716-1369
Mailing Address - Street 1:404 HEARNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-2022
Mailing Address - Country:US
Mailing Address - Phone:318-716-1369
Mailing Address - Fax:318-675-0120
Practice Address - Street 1:404 HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-2022
Practice Address - Country:US
Practice Address - Phone:318-716-1369
Practice Address - Fax:318-675-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health