Provider Demographics
NPI:1326414665
Name:RHA NORTH CAROLINA MR, INC.
Entity Type:Organization
Organization Name:RHA NORTH CAROLINA MR, INC.
Other - Org Name:LEWIS FORK II
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPC-P
Authorized Official - Phone:404-968-2668
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 1:1388 LEWIS FORK BAPTIST CH RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:NC
Practice Address - Zip Code:28624-9080
Practice Address - Country:US
Practice Address - Phone:336-973-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities