Provider Demographics
NPI:1891557492
Name:RISING SUN RECOVERY, INC.
Entity type:Organization
Organization Name:RISING SUN RECOVERY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:CPS-AD
Authorized Official - Phone:404-200-8907
Mailing Address - Street 1:3446 PARSONS GREENE CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4428
Mailing Address - Country:US
Mailing Address - Phone:404-200-8907
Mailing Address - Fax:
Practice Address - Street 1:3446 PARSONS GREENE CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4428
Practice Address - Country:US
Practice Address - Phone:404-200-8907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or Charitable
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003319738AMedicaid