Healthcare Provider Details

I. General information

NPI: 1619871001
Provider Name (Legal Business Name): RISE UP RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 FURLEY AVE
BALTIMORE MD
21206-5735
US

IV. Provider business mailing address

1115 MALKUS WAY
BEL AIR MD
21014-2753
US

V. Phone/Fax

Practice location:
  • Phone: 443-267-8107
  • Fax:
Mailing address:
  • Phone: 443-267-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK RODERICK
Title or Position: COO/COUNSELOR
Credential: CSC-AD
Phone: 443-752-8048