Provider Demographics
NPI:1578339701
Name:RISE SUPPORTS LLC
Entity Type:Organization
Organization Name:RISE SUPPORTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LABA
Authorized Official - Phone:781-635-8349
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:HUMAROCK
Mailing Address - State:MA
Mailing Address - Zip Code:02047-0089
Mailing Address - Country:US
Mailing Address - Phone:781-635-8349
Mailing Address - Fax:
Practice Address - Street 1:1795 BAY ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1006
Practice Address - Country:US
Practice Address - Phone:203-525-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty