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General NPI Number Information
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NPI Number | 1700771714
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Entity Type | Organization
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Legal Business Name | RISE RECOVERY LLC
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 3020 S CALHOUN ST
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City | FORT WAYNE
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State | IN
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Zip | 46807-1408
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Country | US
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Telephone | 260-908-3167
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Fax |
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Provider Business Mailing Address
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Address Line | 112 LINCOLN HWY W
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City | NEW HAVEN
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State | IN
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Zip | 46774-2158
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Country | US
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Telephone | 260-908-3167
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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. RYAN LAWRENCE MARSDEN
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Credential | CADAC 2
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Telephone | 260-908-3167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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