=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003787938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE SERVICES SOUTHERN CORRIDOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 271 W SHORT ST STE 410
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40507-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-389-3630
-----------------------------------------------------
Fax | 703-214-6239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1132
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22026-9132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-389-3630
-----------------------------------------------------
Fax | 703-214-6239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BARBARA ELIZABETH TATE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-843-8556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------