Provider Demographics
NPI:1891557492
Name:RISING SUN RECOVERY, INC.
Entity Type:Organization
Organization Name:RISING SUN RECOVERY, INC.
Other - Org Name:RISING SUN RECOVERY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:CPS-AD
Authorized Official - Phone:404-200-8907
Mailing Address - Street 1:3446 PARSONS GREENE CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4428
Mailing Address - Country:US
Mailing Address - Phone:404-200-8907
Mailing Address - Fax:
Practice Address - Street 1:6736 BILL CARRUTH PKWY APT 901
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3794
Practice Address - Country:US
Practice Address - Phone:678-829-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty