Basic Information
| Provider Information | |||||||||
| NPI: | 1174521488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | R.I.S.A.T., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6185 PASEO DEL NORTE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920111155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552592288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 66 PAVILION AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029051522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014619110 | ||||||||
| FaxNumber: | 4014619194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 02/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANDERSON | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, CTC DIVISION | ||||||||
| AuthorizedOfficialTelephone: | 8552592288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ACADIA HEALTHCARE COMPANY, INC. | ||||||||
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| NPICertificationDate: | 02/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 608 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM2800X | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 261QR0405X | 608 | RI | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 410268 | 01 | RI | BLUECHIP RITECARE | OTHER | SP02546 | 05 | RI | MEDICAID | 1017610 | 01 | RI | BEACON HEALTH STRATEGIES | OTHER | 84-10032 | 01 | RI | UNITED HEALTHCARE | OTHER |