Provider Demographics
NPI:1841570082
Name:RAISEUP COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:RAISEUP COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:RAISEUP LIFE MANAGEMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADC
Authorized Official - Phone:702-592-4814
Mailing Address - Street 1:5328 VISTA HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4095
Mailing Address - Country:US
Mailing Address - Phone:702-592-4814
Mailing Address - Fax:702-631-9475
Practice Address - Street 1:5328 VISTA HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4095
Practice Address - Country:US
Practice Address - Phone:702-592-4814
Practice Address - Fax:702-631-9475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAISEUP COMMUNITY DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4913-S251B00000X
NV5909-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management