Healthcare Provider Details

I. General information

NPI: 1043011653
Provider Name (Legal Business Name): RISING SKY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 OAKMERE DR
HARBOR CITY CA
90710-1531
US

IV. Provider business mailing address

914 OAKMERE DR
HARBOR CITY CA
90710-1531
US

V. Phone/Fax

Practice location:
  • Phone: 323-636-9485
  • Fax:
Mailing address:
  • Phone: 323-636-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHALONDA Y JORDAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-636-9485