MEDICARE: RISE CHARTER ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1336418680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE CHARTER ACADEMY

Provider Business Mailing Address
First Line	:	PO BOX 2837
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79408-2837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 N MARTIN LUTHER KING BLVD
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79403-3412
Country	:	US
Telephone Number	:	806-744-0438
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RICHARD BAUMGARTNER
Credential	:
Telephone Number	:	806-744-0438

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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Directions to “RISE CHARTER ACADEMY ” Practice Location

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