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General NPI Number Information
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NPI Number | 1083323380
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Entity Type | Organization
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Legal Business Name | RISE TOGETHER, LLC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 4931 N ELENA MARIA PL
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City | MERIDIAN
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State | ID
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Zip | 83646-6758
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Country | US
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Telephone | 208-559-2333
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Fax |
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Provider Business Mailing Address
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Address Line | 4949 N ELENA MARIA PL
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City | MERIDIAN
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State | ID
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Zip | 83646-6758
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Country | US
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Telephone | 208-559-2333
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPERATING MANAGER
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Name | BROOKE JOHNSON
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Credential |
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Telephone | 208-559-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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