MEDICARE: UPRISING ADDICTION CENTER, 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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1811512262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPRISING ADDICTION CENTER, LLC

Provider Business Mailing Address
First Line	:	7020 KLUG PINES RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3300
Country	:	US
Telephone Number	:	318-683-4622
Fax Number	:	318-683-4625

Provider Business Practice Location Address
First Line	:	7020 KLUG PINES RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3300
Country	:	US
Telephone Number	:	703-795-8793
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN HOLLINS
Credential	:
Telephone Number	:	318-683-4622

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	06/09/2021

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Directions to “UPRISING ADDICTION CENTER, LLC ” Practice Location

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