Provider Demographics
NPI:1669514683
Name:ROBESON HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:ROBESON HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CHIEF OF BEHAVIORAL HEALTH SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:910-521-2900
Mailing Address - Street 1:60 COMMERCE PLAZA
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2590
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9164
Practice Address - Street 1:3750 MEADOW VIEW RD
Practice Address - Street 2:APT. A-1
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-1920
Practice Address - Country:US
Practice Address - Phone:910-618-9912
Practice Address - Fax:910-618-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-111101YA0400X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005786Medicaid
NC8300802GMedicaid
NC8300802PMedicaid
NC8300802QMedicaid
NC8300802Medicaid
NC8300802BMedicaid