Provider Demographics
NPI:1255129698
Name:RISING PHOENIX COMMUNITY ORGANIZATION
Entity type:Organization
Organization Name:RISING PHOENIX COMMUNITY ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:805-440-6471
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93483-0331
Mailing Address - Country:US
Mailing Address - Phone:805-440-6471
Mailing Address - Fax:805-941-1026
Practice Address - Street 1:558 CAMINO MERCADO
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1815
Practice Address - Country:US
Practice Address - Phone:805-941-1025
Practice Address - Fax:805-941-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty