Healthcare Provider Details

I. General information

NPI: 1245969880
Provider Name (Legal Business Name): RISE UP RECOVER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 W ROOSEVELT ST STE 223
GOODYEAR AZ
85338-9306
US

IV. Provider business mailing address

15655 W ROOSEVELT ST STE 223
GOODYEAR AZ
85338-9306
US

V. Phone/Fax

Practice location:
  • Phone: 602-698-8990
  • Fax:
Mailing address:
  • Phone: 602-698-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RIA FLANAGAN
Title or Position: OWNER
Credential: MA MFT, LISAC. CSAT
Phone: 602-698-8990