MEDICARE: RISING GROUND. INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center
2	251V00000X	Voluntary or Charitable Agency

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

NPI Number	:	1710957683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING GROUND. INC

Provider Business Mailing Address
First Line	:	1333 BROADWAY FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-1064
Country	:	US
Telephone Number	:	212-437-3500
Fax Number	:	914-375-8902

Provider Business Practice Location Address
First Line	:	463 HAWTHORNE AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10705-3441
Country	:	US
Telephone Number	:	914-375-8719
Fax Number	:	914-375-8902

Authorized Official
Title or Position	:	BILLING AND CONTRACTING MANAGER
Name	:	MS. NANCY VELASQUEZ
Credential	:	CPC
Telephone Number	:	347-963-8562

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/13/2026

463 HAWTHORNE AVE , LEAKE AND WATTS SERVICES, INC
YONKERS, NY
10705-3441

Practice Phone: 914-375-8756
Practice Fax: 914-375-8901