Provider Demographics
NPI:1811877574
Name:RISE RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:RISE RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-405-5443
Mailing Address - Street 1:6411 LICKING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7435
Mailing Address - Country:US
Mailing Address - Phone:804-918-0502
Mailing Address - Fax:
Practice Address - Street 1:6411 LICKING CREEK DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-7435
Practice Address - Country:US
Practice Address - Phone:804-918-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities