Provider Demographics
NPI:1669755567
Name:RISE -RESOURCE,INFORMATION,SUPPORT AND EMPOWERMENT
Entity type:Organization
Organization Name:RISE -RESOURCE,INFORMATION,SUPPORT AND EMPOWERMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHEL
Authorized Official - Last Name:BROCATO
Authorized Official - Suffix:
Authorized Official - Credentials:BA,MAHS
Authorized Official - Phone:409-832-2599
Mailing Address - Street 1:755 S 11TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3732
Mailing Address - Country:US
Mailing Address - Phone:409-832-2599
Mailing Address - Fax:
Practice Address - Street 1:755 S 11TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3732
Practice Address - Country:US
Practice Address - Phone:409-832-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable