| Rise Psychiatric Llc | |
|
2020 Chaucer Ln Ponte Vedra FL 32081-7074 | |
| (720) 448-8858 | |
| Not Available |
| Full Name | Rise Psychiatric Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2020 Chaucer Ln, Ponte Vedra, Florida |
| Authorized Official Name and Position | Katherine A Soine (PRESIDENT) |
| Authorized Official Contact | 7204488858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rise Psychiatric Llc 2020 Chaucer Ln Ponte Vedra FL 32081-7074 Ph: (720) 448-8858 | Rise Psychiatric Llc 2020 Chaucer Ln Ponte Vedra FL 32081-7074 Ph: (720) 448-8858 |
| NPI Number | 1962186155 |
|---|---|
| Provider Enumeration Date | 06/09/2023 |
| Last Update Date | 11/17/2024 |
| Certification Date | 11/17/2024 |
| Medicare PECOS PAC ID | 5395272975 |
|---|---|
| Medicare Enrollment ID | O20241220000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962186155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Katherine Anita Soine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255096343 PECOS PAC ID: 6204363880 Enrollment ID: I20241220000036 |
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