Provider Demographics
NPI:1699387688
Name:RISE REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:RISE REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-515-1152
Mailing Address - Street 1:738 HIGHLAND PARK TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6706
Mailing Address - Country:US
Mailing Address - Phone:267-515-1152
Mailing Address - Fax:
Practice Address - Street 1:738 HIGHLAND PARK TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6706
Practice Address - Country:US
Practice Address - Phone:267-515-1152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
738OtherOFFICE 1