Healthcare Provider Details

I. General information

NPI: 1568924306
Provider Name (Legal Business Name): RISE PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41000 WOODWARD AVE STE 350
BLOOMFIELD HILLS MI
48304-5092
US

IV. Provider business mailing address

2325 LERWICK LN
MILFORD MI
48381-1303
US

V. Phone/Fax

Practice location:
  • Phone: 248-850-1000
  • Fax:
Mailing address:
  • Phone: 734-308-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHEL MARY ESHKANIAN
Title or Position: PROVIDER, OWNER
Credential: PA-C
Phone: 734-308-0505