Provider Demographics
NPI:1255574034
Name:GREATER IMAGE HEALTHCARE, CORP
Entity type:Organization
Organization Name:GREATER IMAGE HEALTHCARE, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-321-0069
Mailing Address - Street 1:401 ROBERSON STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5423
Mailing Address - Country:US
Mailing Address - Phone:910-321-0069
Mailing Address - Fax:910-491-1000
Practice Address - Street 1:401 ROBERSON STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5423
Practice Address - Country:US
Practice Address - Phone:910-321-0069
Practice Address - Fax:910-491-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457481988Medicaid
NC8302847Medicaid
NC1508996059Medicaid
NC5919267Medicaid
NC6008694Medicaid