Healthcare Provider Details

I. General information

NPI: 1053685685
Provider Name (Legal Business Name): RISE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 W BUSINESS PARK DR
OREM UT
84058-2203
US

IV. Provider business mailing address

1358 W BUSINESS PARK DR
OREM UT
84058-2203
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-1197
  • Fax: 801-373-1198
Mailing address:
  • Phone: 801-373-1197
  • Fax: 801-373-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUNNY TODHUNTER
Title or Position: COMMUNITY SERVICE BROKER
Credential:
Phone: 801-717-2399