Provider Demographics
NPI:1912601196
Name:RISE SUPPORTED LIVING
Entity Type:Organization
Organization Name:RISE SUPPORTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SAKINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVEREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-364-4264
Mailing Address - Street 1:10979 REED HARTMAN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2888
Mailing Address - Country:US
Mailing Address - Phone:513-364-4264
Mailing Address - Fax:
Practice Address - Street 1:10979 REED HARTMAN HWY STE 101
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2888
Practice Address - Country:US
Practice Address - Phone:513-364-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care