Provider Demographics
NPI:1760130066
Name:RISE AND SHINE RESIDENTIAL CARE
Entity Type:Organization
Organization Name:RISE AND SHINE RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MAZURU
Authorized Official - Last Name:CHIMANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-320-4871
Mailing Address - Street 1:1400 10TH AVE NE APT 221
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-2876
Mailing Address - Country:US
Mailing Address - Phone:170-132-0487
Mailing Address - Fax:
Practice Address - Street 1:1400 10TH AVE NE APT 221
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2876
Practice Address - Country:US
Practice Address - Phone:170-132-0487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health