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General NPI Number Information
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NPI Number | 1033930433
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Entity Type | Organization
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Legal Business Name | RISE ABOVE SANCTUARY, LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 107 SCHOOL ST
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City | BELMONT
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State | NC
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Zip | 28012-2120
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Country | US
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Telephone | 443-769-8517
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Fax |
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Provider Business Mailing Address
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Address Line | 15830 HOMECOMING WAY
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City | CHARLOTTE
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State | NC
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Zip | 28278-7871
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Country | US
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Telephone | 443-769-8517
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEMON BROWN
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Credential |
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Telephone | 443-769-8517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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