Provider Demographics
NPI:1891527057
Name:RISING PHOENIX THERAPEUTIC COMMUNITY & RESCUE CENTER
Entity type:Organization
Organization Name:RISING PHOENIX THERAPEUTIC COMMUNITY & RESCUE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NCC, LPC, CCTP-
Authorized Official - Phone:307-251-1852
Mailing Address - Street 1:444 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2826
Mailing Address - Country:US
Mailing Address - Phone:307-251-1852
Mailing Address - Fax:
Practice Address - Street 1:444 S CENTER ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2826
Practice Address - Country:US
Practice Address - Phone:307-251-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health