Healthcare Provider Details

I. General information

NPI: 1992647804
Provider Name (Legal Business Name): FROM ASHES WE RISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 ROESTA LN NW
BALTIMORE OH
43105-9200
US

IV. Provider business mailing address

12124 ROESTA LN NW
BALTIMORE OH
43105-9200
US

V. Phone/Fax

Practice location:
  • Phone: 614-582-2977
  • Fax: 614-591-3744
Mailing address:
  • Phone: 614-582-2977
  • Fax: 614-591-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LETISHA LEACH
Title or Position: OWNER
Credential: APRN, FNP, PMHNP
Phone: 614-300-7977