Provider Demographics
NPI:1982061115
Name:RISE CENTER FOR RECOVERY
Entity Type:Organization
Organization Name:RISE CENTER FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LADC,
Authorized Official - Phone:918-521-8565
Mailing Address - Street 1:223 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3249
Mailing Address - Country:US
Mailing Address - Phone:918-822-4499
Mailing Address - Fax:
Practice Address - Street 1:223 N EAST AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3249
Practice Address - Country:US
Practice Address - Phone:918-822-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health