MEDICARE: RISING YOUTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1225974959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING YOUTH LLC

Provider Business Mailing Address
First Line	:	6650 W STATE ST
Second Line	:	PO BOX D-202
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-2827
Country	:	US
Telephone Number	:	414-467-9086
Fax Number	:

Provider Business Practice Location Address
First Line	:	4731 N 80TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4619
Country	:	US
Telephone Number	:	414-467-9086
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW ARCHIE
Credential	:
Telephone Number	:	414-467-9086

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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