Provider Demographics
NPI:1558733527
Name:ARISE MENTORS, LLP
Entity Type:Organization
Organization Name:ARISE MENTORS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:REX
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:503-893-5353
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-0709
Mailing Address - Country:US
Mailing Address - Phone:503-893-5353
Mailing Address - Fax:
Practice Address - Street 1:5676 SE GARNET WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-6252
Practice Address - Country:US
Practice Address - Phone:503-893-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDPO1413251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services