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General NPI Number Information
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NPI Number | 1669755567
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Entity Type | Organization
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Legal Business Name | RISE -RESOURCE,INFORMATION,SUPPORT AND EMPOWERMENT
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 755 S 11TH ST SUITE 101
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City | BEAUMONT
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State | TX
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Zip | 77701-3732
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Country | US
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Telephone | 409-832-2599
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Fax |
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Provider Business Mailing Address
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Address Line | 755 S 11TH ST SUITE 101
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City | BEAUMONT
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State | TX
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Zip | 77701-3732
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Country | US
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Telephone | 409-832-2599
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES MICHEL BROCATO
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Credential | BA,MAHS
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Telephone | 409-832-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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