MEDICARE: RISE UP RECOVERY CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	261QU0200X	Urgent Care Clinic/Center
3	163WP0808X	Psychiatric/Mental Health Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14536856	OTHER	OH	CAQH

General Provider Information

NPI Number	:	1770295032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE UP RECOVERY CARE

Provider Business Mailing Address
First Line	:	2861 ZACH DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-5010
Country	:	US
Telephone Number	:	614-900-1807
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 ZACH DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-5010
Country	:	US
Telephone Number	:	614-900-1807
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	MRS. NAFISA IBRAHIM
Credential	:	REGISTERED NURSE
Telephone Number	:	614-900-1807

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	02/22/2023

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Directions to “RISE UP RECOVERY CARE ” Practice Location

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