MEDICARE: HOPE RISING YOUTH RESIDENTIAL

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1871459826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE RISING YOUTH RESIDENTIAL

Provider Business Mailing Address
First Line	:	3701 BENTON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2303
Country	:	US
Telephone Number	:	470-774-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 WATTS LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1939
Country	:	US
Telephone Number	:	470-774-9041
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SELENA RICHARDSON
Credential	:
Telephone Number	:	470-774-9041

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/18/2026

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