MEDICARE: RISE AUTISM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1053907808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE AUTISM LLC

Provider Business Mailing Address
First Line	:	239 E WINSLOW RD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-8638
Country	:	US
Telephone Number	:	812-929-2271
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 E WINSLOW RD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-8638
Country	:	US
Telephone Number	:	812-929-2271
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KIRK GRABER
Credential	:	BCBA
Telephone Number	:	812-929-2271

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	01/13/2025

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Directions to “RISE AUTISM LLC ” Practice Location

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