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General NPI Number Information
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NPI Number | 1619871001
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Entity Type | Organization
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Legal Business Name | RISE UP RECOVERY LLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 4304 FURLEY AVE
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City | BALTIMORE
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State | MD
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Zip | 21206-5735
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Country | US
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Telephone | 443-267-8107
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 MALKUS WAY
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City | BEL AIR
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State | MD
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Zip | 21014-2753
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Country | US
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Telephone | 443-267-8107
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Fax |
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Authorized Official
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Title or Position | COO/COUNSELOR
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Name | PATRICK RODERICK
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Credential | CSC-AD
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Telephone | 443-752-8048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | NULL
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