Provider Demographics
NPI:1669896130
Name:RISING HOPE CLINICAL ASSISTANCE, LLC
Entity type:Organization
Organization Name:RISING HOPE CLINICAL ASSISTANCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-707-1415
Mailing Address - Street 1:168 CAROL PL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7312
Mailing Address - Country:US
Mailing Address - Phone:704-661-3327
Mailing Address - Fax:877-564-4386
Practice Address - Street 1:21 E STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-0109
Practice Address - Country:US
Practice Address - Phone:614-726-1485
Practice Address - Fax:877-564-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0430058Medicaid