Provider Demographics
NPI:1942483193
Name:UMOJA BEHAVIORAL HEALTH CARE, LLC
Entity Type:Organization
Organization Name:UMOJA BEHAVIORAL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-912-4814
Mailing Address - Street 1:108 TUCKASEEGE RD
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1948
Mailing Address - Country:US
Mailing Address - Phone:770-912-4814
Mailing Address - Fax:478-285-4575
Practice Address - Street 1:108 TUCKASEEGE RD
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1948
Practice Address - Country:US
Practice Address - Phone:704-827-1968
Practice Address - Fax:704-827-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization