MEDICARE: THE RIZEN ONE MINISTRIES,INC.

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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1548747694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RIZEN ONE MINISTRIES,INC.

Provider Business Mailing Address
First Line	:	4757 STONE MOUNTAIN HWY STE 800
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-0010
Country	:	US
Telephone Number	:	470-922-2295
Fax Number	:

Provider Business Practice Location Address
First Line	:	4757 STONE MOUNTAIN HWY STE 800
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-0010
Country	:	US
Telephone Number	:	470-922-2295
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. RICHARD LEE DAWSON
Credential	:
Telephone Number	:	678-923-0903

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	07/22/2018

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