Provider Demographics
NPI:1538698576
Name:RISE CENTER FOR AUTISM
Entity Type:Organization
Organization Name:RISE CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:FICAJ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:989-202-5737
Mailing Address - Street 1:140 ALGONQUIN DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9356
Mailing Address - Country:US
Mailing Address - Phone:989-965-3274
Mailing Address - Fax:
Practice Address - Street 1:1840 W HOUGHTON LAKE DR UNIT 2
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651-9672
Practice Address - Country:US
Practice Address - Phone:989-965-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center