Provider Demographics
NPI:1063094878
Name:RISE UP HEALTH CLINICS
Entity type:Organization
Organization Name:RISE UP HEALTH CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIEHE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:651-653-2923
Mailing Address - Street 1:5045 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2663
Mailing Address - Country:US
Mailing Address - Phone:651-653-2923
Mailing Address - Fax:
Practice Address - Street 1:5045 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2663
Practice Address - Country:US
Practice Address - Phone:651-653-2923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RISE UP HEALTH CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-22
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center