MEDICARE: MAEVE RISING

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
1	104100000X	Social Worker	I.2102623	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316445265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEVE RISING

Provider Business Mailing Address
First Line	:	DEPT. 781625
Second Line	:	PO BOX 78000
City	:	DETROIT
State	:	MI
Zip	:	48278-1625
Country	:	US
Telephone Number	:	614-355-8004
Fax Number	:	614-355-2220

Provider Business Practice Location Address
First Line	:	1385 KING AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2220
Country	:	US
Telephone Number	:	614-427-3429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	10/29/2024

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Directions to “ MAEVE RISING ” Practice Location

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