Healthcare Provider Details

I. General information

NPI: 1619704707
Provider Name (Legal Business Name): RISE OF RUSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E TEXAS AVE
RUSTON LA
71270-4555
US

IV. Provider business mailing address

512 E TEXAS AVE
RUSTON LA
71270-4555
US

V. Phone/Fax

Practice location:
  • Phone: 318-331-3977
  • Fax:
Mailing address:
  • Phone: 318-331-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. FELICIA DOUGLAS
Title or Position: OWNER
Credential:
Phone: 318-224-9088