Healthcare Provider Details

I. General information

NPI: 1417846064
Provider Name (Legal Business Name): HEAL & RISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 INDIANA AVE
CHESAPEAKE VA
23321-2713
US

IV. Provider business mailing address

4528 INDIANA AVE
CHESAPEAKE VA
23321-2713
US

V. Phone/Fax

Practice location:
  • Phone: 757-381-6625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEEDAIJAH LAHY
Title or Position: CEO
Credential:
Phone: 757-381-6625