Healthcare Provider Details

I. General information

NPI: 1750190211
Provider Name (Legal Business Name): RISE & THRIVE TRANSITIONAL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10369 MILLS TOWER DR
RANCHO CORDOVA CA
95670-5444
US

IV. Provider business mailing address

10369 MILLS TOWER DR
RANCHO CORDOVA CA
95670-5444
US

V. Phone/Fax

Practice location:
  • Phone: 916-710-3224
  • Fax:
Mailing address:
  • Phone: 916-710-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LEAH ROBERSON
Title or Position: MEMBER
Credential:
Phone: 916-710-3224