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General NPI Number Information
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NPI Number | 1760979488
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Entity Type | Organization
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Legal Business Name | R.I.S.E. COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 333 TEXAS ST STE 1300
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City | SHREVEPORT
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State | LA
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Zip | 71101-3783
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Country | US
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Telephone | 888-312-7473
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52104
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City | SHREVEPORT
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State | LA
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Zip | 71135-2104
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Country | US
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Telephone | 225-620-5617
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. RALPHEAL JOHNSON
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Credential |
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Telephone | 225-620-5617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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