Healthcare Provider Details

I. General information

NPI: 1265371272
Provider Name (Legal Business Name): RISE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5583 DALEWOOD AVE
MAPLE HEIGHTS OH
44137-3435
US

IV. Provider business mailing address

5583 DALEWOOD AVE
MAPLE HEIGHTS OH
44137-3435
US

V. Phone/Fax

Practice location:
  • Phone: 216-704-4172
  • Fax:
Mailing address:
  • Phone: 216-704-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN SMITH
Title or Position: CEO
Credential: SMITH
Phone: 216-704-4172