Provider Demographics
NPI:1508529827
Name:ARISE RECOVERY RESIDENCES
Entity Type:Organization
Organization Name:ARISE RECOVERY RESIDENCES
Other - Org Name:ARISE RECOVERY & BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CAC II, NCAC II
Authorized Official - Phone:678-216-6706
Mailing Address - Street 1:116 PEACHTREE CT STE A
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4800
Mailing Address - Country:US
Mailing Address - Phone:678-725-2631
Mailing Address - Fax:770-719-2368
Practice Address - Street 1:116 PEACHTREE CT STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4800
Practice Address - Country:US
Practice Address - Phone:770-719-1746
Practice Address - Fax:770-719-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2022-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADRUG012980OtherDATEP LICENSE