Healthcare Provider Details

I. General information

NPI: 1396448387
Provider Name (Legal Business Name): RISE BEYOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 N 7TH ST LOT 11
ST AUGUSTINE FL
32084-1860
US

IV. Provider business mailing address

2925 N 7TH ST LOT 11
ST AUGUSTINE FL
32084-1860
US

V. Phone/Fax

Practice location:
  • Phone: 904-673-4064
  • Fax:
Mailing address:
  • Phone: 904-673-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHARIF A JALIL
Title or Position: OWNER
Credential: CNA
Phone: 904-217-2787