Provider Demographics
NPI: | 1083746291 |
---|---|
Name: | RHA HEALTH SERVICES NC, LLC |
Entity Type: | Organization |
Organization Name: | RHA HEALTH SERVICES NC, LLC |
Other - Org Name: | MAXTON |
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: | 15235 AIRPORT RD |
Practice Address - Street 2: | |
Practice Address - City: | MAXTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28364-6821 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-844-9664 |
Practice Address - Fax: | 911-844-9668 |
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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8300279H | Medicaid |