Provider Demographics
NPI:1710126792
Name:RISINGABOVE INDEPENDENT SUPPORTED LIVING
Entity Type:Organization
Organization Name:RISINGABOVE INDEPENDENT SUPPORTED LIVING
Other - Org Name:RISINGABOVE INDEPENDENT SUPPORTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-532-9029
Mailing Address - Street 1:2330 # 2 WOODSON ROAD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114
Mailing Address - Country:US
Mailing Address - Phone:314-532-9029
Mailing Address - Fax:
Practice Address - Street 1:2330 # 2 WOODSON ROAD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114
Practice Address - Country:US
Practice Address - Phone:314-532-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness