MEDICARE: RISE SERVICES SOUTHERN CORRIDOR LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1003787938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE SERVICES SOUTHERN CORRIDOR LLC

Provider Business Mailing Address
First Line	:	PO BOX 1132
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22026-9132
Country	:	US
Telephone Number	:	571-389-3630
Fax Number	:	703-214-6239

Provider Business Practice Location Address
First Line	:	271 W SHORT ST STE 410
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40507-1213
Country	:	US
Telephone Number	:	571-389-3630
Fax Number	:	703-214-6239

Authorized Official
Title or Position	:	CEO
Name	:	BARBARA ELIZABETH TATE
Credential	:
Telephone Number	:	703-843-8556

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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