Provider Demographics
NPI:1669142873
Name:RISE HOME HEALTHCARE AGENCY
Entity type:Organization
Organization Name:RISE HOME HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMIKONYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-323-5559
Mailing Address - Street 1:1105 SCHROCK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1174
Mailing Address - Country:US
Mailing Address - Phone:614-505-6116
Mailing Address - Fax:
Practice Address - Street 1:1105 SCHROCK RD STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1174
Practice Address - Country:US
Practice Address - Phone:614-505-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health