Healthcare Provider Details

I. General information

NPI: 1942170089
Provider Name (Legal Business Name): NORTHRISE WELLNESS & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2884 N ROADRUNNER PKWY
LAS CRUCES NM
88011-0853
US

IV. Provider business mailing address

2884 N ROADRUNNER PKWY
LAS CRUCES NM
88011-0853
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-1110
  • Fax:
Mailing address:
  • Phone: 575-522-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID GARETZ
Title or Position: CFO
Credential:
Phone: 323-987-5954