MEDICARE: RISE AGAIN RECOVERY INC.

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1568946192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE AGAIN RECOVERY INC.

Provider Business Mailing Address
First Line	:	20932 BROOKHURST ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-6638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20681 CHAUCER LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-5809
Country	:	US
Telephone Number	:	657-259-0691
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JAMES SEWELL
Credential	:
Telephone Number	:	562-522-8530

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	09/19/2018

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