Healthcare Provider Details

I. General information

NPI: 1346181070
Provider Name (Legal Business Name): RISE AND RESTORE RECOVERY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 NARCISSUS AVE
BALTIMORE MD
21215-4520
US

IV. Provider business mailing address

3811 W COLD SPRING LN
BALTIMORE MD
21215-5430
US

V. Phone/Fax

Practice location:
  • Phone: 443-803-4950
  • Fax:
Mailing address:
  • Phone: 443-814-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY LYNN ELLIOTT
Title or Position: CONSULTANT
Credential: CSC-AD
Phone: 443-814-1120