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NPI Code Detail

MEDICARE: UPRISE BEHAVIORAL HEALTH LLC

MEDICARE: UPRISE BEHAVIORAL HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1043893662
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPRISE BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 13701 5TH AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3109
Country : US
Telephone Number : 216-659-5406
Fax Number :
Provider Business Practice Location Address
First Line : 5 SEVERANCE CIR STE 201
Second Line :
City : CLEVELAND HTS
State : OH
Zip : 44118-1567
Country : US
Telephone Number : 216-659-5406
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MICKIE CHANEY
Credential : LISW-S, LICDC
Telephone Number : 216-659-5406
Provider Enumeration Date : 05/02/2021
Last Update Date : 05/02/2021

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Directions to “UPRISE BEHAVIORAL HEALTH LLC ” Practice Location

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