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NPI Code Detail

MEDICARE: R.I.S.E. COMMUNITY SERVICES LLC

MEDICARE: R.I.S.E. COMMUNITY SERVICES 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 : 1760979488
Entity Type Code : Organization
Provider Name (Legal Business Name) : R.I.S.E. COMMUNITY SERVICES LLC
Provider Business Mailing Address
First Line : PO BOX 52104
Second Line :
City : SHREVEPORT
State : LA
Zip : 71135-2104
Country : US
Telephone Number : 225-620-5617
Fax Number :
Provider Business Practice Location Address
First Line : 333 TEXAS ST STE 1300
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3783
Country : US
Telephone Number : 888-312-7473
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. RALPHEAL JOHNSON
Credential :
Telephone Number : 225-620-5617
Provider Enumeration Date : 04/18/2018
Last Update Date : 04/18/2018

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