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General NPI Number Information
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NPI Number | 1538698576
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Entity Type | Organization
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Legal Business Name | RISE CENTER FOR AUTISM
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1840 W HOUGHTON LAKE DR UNIT 2
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City | PRUDENVILLE
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State | MI
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Zip | 48651-9672
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Country | US
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Telephone | 989-965-3274
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Fax |
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Provider Business Mailing Address
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Address Line | 140 ALGONQUIN DR
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-9356
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Country | US
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Telephone | 989-965-3274
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. MARGARET YVONNE FICAJ
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Credential | BCBA
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Telephone | 989-202-5737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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