Provider Demographics
NPI:1477000776
Name:RISING ROADS RECOVERY SERVICES FOR WOMEN, LLC
Entity type:Organization
Organization Name:RISING ROADS RECOVERY SERVICES FOR WOMEN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-922-1901
Mailing Address - Street 1:3151 AIRWAY AVE STE I3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4624
Mailing Address - Country:US
Mailing Address - Phone:949-922-1901
Mailing Address - Fax:714-786-8986
Practice Address - Street 1:11388 SNOWDROP AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1756
Practice Address - Country:US
Practice Address - Phone:866-746-1558
Practice Address - Fax:714-786-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300659AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility