Provider Demographics
NPI:1992313274
Name:RISE WOMENS SELF RECOVERY LLC
Entity type:Organization
Organization Name:RISE WOMENS SELF RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIXINHO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:505-484-9154
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-0305
Mailing Address - Country:US
Mailing Address - Phone:505-484-9154
Mailing Address - Fax:
Practice Address - Street 1:507 W PUEBLO DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2508
Practice Address - Country:US
Practice Address - Phone:505-484-9154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health