1003787938 NPI number — RISE SERVICES SOUTHERN CORRIDOR LLC

Table of content: MRS. LISA ANN JESKE LMT, RN (NPI 1780196188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003787938 NPI number — RISE SERVICES SOUTHERN CORRIDOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RISE SERVICES SOUTHERN CORRIDOR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003787938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
271 W SHORT ST STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40507-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-389-3630
Provider Business Practice Location Address Fax Number:
703-214-6239
Provider Enumeration Date:
09/15/2025

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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