Provider Demographics
NPI:1174658447
Name:RHA HEALTH SERVICES NC, LLC
Entity type:Organization
Organization Name:RHA HEALTH SERVICES NC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2527 E LYON STATION RD
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9112
Practice Address - Country:US
Practice Address - Phone:919-528-2558
Practice Address - Fax:919-528-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301122Medicaid