Provider Demographics
NPI:1255707485
Name:RISE (RESTORING INDIVIDUALS WITH SPIRITUAL ENRICHMENT)
Entity type:Organization
Organization Name:RISE (RESTORING INDIVIDUALS WITH SPIRITUAL ENRICHMENT)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERIOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMPSON-BEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:731-352-9797
Mailing Address - Street 1:12808 W AIRPORT BLVD
Mailing Address - Street 2:3250
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-6184
Mailing Address - Country:US
Mailing Address - Phone:713-352-9797
Mailing Address - Fax:
Practice Address - Street 1:12808 W AIRPORT BLVD
Practice Address - Street 2:3250
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6184
Practice Address - Country:US
Practice Address - Phone:713-352-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMSW251B00000X, 251S00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health