=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700275484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE AGAIN RECOVERY AND WELLNESS LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2015
-----------------------------------------------------
Last Update Date | 01/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 NE 125TH ST
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-4755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-895-1433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 NE 125TH ST
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-4755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-895-1433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MRS. ERIN COHEN-GIRALDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-614-0508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------