Healthcare Provider Details

I. General information

NPI: 1427471143
Provider Name (Legal Business Name): RISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 06/24/2014
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
OREM UT
84058
US

V. Phone/Fax

Practice location:
  • Phone: 801-717-2387
  • Fax:
Mailing address:
  • Phone: 801-717-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2014-HHA-UT000654
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2014-HHA-UT000654
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier2014-HHA-UT000654
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerLICENSE

VIII. Authorized Official

Name: SHERRIE STANTON
Title or Position: OPERATIONS SPECIALIST
Credential:
Phone: 801-717-2387