=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962379461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE RECOVERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1290 CONGRESS ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-710-9924
-----------------------------------------------------
Fax | 207-710-9924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1290 CONGRESS ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-710-9924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LACEY L KNIGHTS
-----------------------------------------------------
Credential | LADC, CCS
-----------------------------------------------------
Telephone | 207-710-9924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------