Provider Demographics
NPI:1528604501
Name:RISE RECOVERY
Entity Type:Organization
Organization Name:RISE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-733-6490
Mailing Address - Street 1:395 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4409
Mailing Address - Country:US
Mailing Address - Phone:909-733-6490
Mailing Address - Fax:213-986-4916
Practice Address - Street 1:395 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4409
Practice Address - Country:US
Practice Address - Phone:909-733-6490
Practice Address - Fax:213-986-4916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATION ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336598259Medicaid