Healthcare Provider Details

I. General information

NPI: 1447607817
Provider Name (Legal Business Name): RISING GROUND. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LIVINGSTON ST
BROOKLYN NY
11201-1260
US

IV. Provider business mailing address

1333 BROADWAY FL 8
NEW YORK NY
10018-1064
US

V. Phone/Fax

Practice location:
  • Phone: 212-437-3500
  • Fax:
Mailing address:
  • Phone: 212-437-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DREISLY VILLAMAN
Title or Position: MEDICAL BILLER
Credential:
Phone: 914-375-8700