Organization
WE RISE, LLC
Active
Organization
WE RISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUANITA RENE TUCKER LCSW (CEO)
(503) 317-4240
Entity
Organization
Contact information
Practice address
3311 NE MLK JR BLVD, 104, PORTLAND, OR 97212-2086
(503) 317-4240
Mailing address
4216 NE RODNEY AVE, PORTLAND, OR 97211-3428
(503) 317-4240
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
L4517
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500664189
—
OR
Enumeration date
08/13/2016
Last updated
08/13/2016
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