Healthcare Provider Details

I. General information

NPI: 1114662020
Provider Name (Legal Business Name): RIZE STRONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSPITAL DR STE 1203
HURRICANE WV
25526-8706
US

IV. Provider business mailing address

PO BOX 650
SCOTT DEPOT WV
25560-0650
US

V. Phone/Fax

Practice location:
  • Phone: 304-370-3327
  • Fax: 888-919-3327
Mailing address:
  • Phone: 304-370-3327
  • Fax: 888-919-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEVASHISH DESAI
Title or Position: CEO
Credential:
Phone: 304-553-5878