MEDICARE: RISE HOMES

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	251S00000X	Community/Behavioral Health Agency

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	:	1316644271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE HOMES

Provider Business Mailing Address
First Line	:	570 W CHEYENNE AVE STE 190
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3983
Country	:	US
Telephone Number	:	702-350-1898
Fax Number	:	888-892-2061

Provider Business Practice Location Address
First Line	:	570 W CHEYENNE AVE STE 190
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3983
Country	:	US
Telephone Number	:	702-350-1898
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEJA FUIMAONO
Credential	:	LCSW
Telephone Number	:	916-753-8309

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	03/07/2026

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Directions to “RISE HOMES ” Practice Location

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