Provider Demographics
NPI:1891104402
Name:RISING UP YOUTH SERVICES
Entity type:Organization
Organization Name:RISING UP YOUTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVAE
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-755-9662
Mailing Address - Street 1:6241 BULLRING LANE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130
Mailing Address - Country:US
Mailing Address - Phone:702-755-9662
Mailing Address - Fax:
Practice Address - Street 1:6241 BULLRING LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1330
Practice Address - Country:US
Practice Address - Phone:702-755-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20051453074251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health