Healthcare Provider Details

I. General information

NPI: 1053907808
Provider Name (Legal Business Name): RISE AUTISM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E WINSLOW RD
BLOOMINGTON IN
47401-8638
US

IV. Provider business mailing address

239 E WINSLOW RD
BLOOMINGTON IN
47401-8638
US

V. Phone/Fax

Practice location:
  • Phone: 812-929-2271
  • Fax:
Mailing address:
  • Phone: 812-929-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK GRABER
Title or Position: OWNER
Credential: BCBA
Phone: 812-929-2271