Provider Demographics
NPI:1053443481
Name:RHA HEALTH SERVICES NC, LLC
Entity Type:Organization
Organization Name:RHA HEALTH SERVICES NC, LLC
Other - Org Name:BENSON
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-364-2900
Mailing Address - Street 1:1819 PEACHTREE RD NE
Mailing Address - Street 2:STE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1848
Mailing Address - Country:US
Mailing Address - Phone:404-364-2900
Mailing Address - Fax:404-364-2901
Practice Address - Street 1:501 S WALL ST STE C
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1856
Practice Address - Country:US
Practice Address - Phone:919-894-5124
Practice Address - Fax:919-894-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301545BMedicaid