NPI Code Detail JSON Logo

1619871001 NPI number — RISE UP RECOVERY LLC

NPI Number: 1619871001
Health Care Provider/Practitioner: RISE UP RECOVERY LLC

Information about “1619871001” NPI (RISE UP RECOVERY LLC) exists in 1619871001 in HTML format HTML  |  1619871001 in plain Text format TXT  |  1619871001 in PDF (Portable Document Format) PDF  |  1619871001 in an XML format XML  formats.

NPI Number : 1619871001 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619871001",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RISE UP RECOVERY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1115 MALKUS WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEL AIR",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21014-2753",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "443-267-8107",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4304 FURLEY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21206-5735",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "443-267-8107",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/07/2026",
    "LastUpdateDate": "10/07/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RODERICK",
    "AuthorizedOfficialFirstName": "PATRICK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "COO/COUNSELOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CSC-AD",
    "AuthorizedOfficialTelephoneNumber": "443-752-8048",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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