MEDICARE: RISE WELLNESS CENTER 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1265371272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	5583 DALEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3435
Country	:	US
Telephone Number	:	216-704-4172
Fax Number	:

Provider Business Practice Location Address
First Line	:	5583 DALEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3435
Country	:	US
Telephone Number	:	216-704-4172
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOCELYN SMITH
Credential	:	SMITH
Telephone Number	:	216-704-4172

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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