Healthcare Provider Details

I. General information

NPI: 1083417943
Provider Name (Legal Business Name): RISE AND REVITALIZE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 EVERGREEN DR
BROWNSVILLE WI
53006-2606
US

IV. Provider business mailing address

PO BOX 123
BROWNSVILLE WI
53006-0123
US

V. Phone/Fax

Practice location:
  • Phone: 920-585-0574
  • Fax:
Mailing address:
  • Phone: 920-585-0574
  • Fax:

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: EMILY R FINK
Title or Position: OWNER/CCS PROVIDER
Credential:
Phone: 920-585-0574