Provider Demographics
NPI:1700660370
Name:RISE ABOVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:RISE ABOVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-691-7726
Mailing Address - Street 1:14401 N LINCOLN BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3405
Mailing Address - Country:US
Mailing Address - Phone:281-691-7726
Mailing Address - Fax:
Practice Address - Street 1:14401 N LINCOLN BLVD STE 109
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3405
Practice Address - Country:US
Practice Address - Phone:281-691-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health