MEDICARE: RHA HEALTH SERVICES NC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-060-139	NC
2	311ZA0620X	Adult Care Home Facility	MHL-060-139	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689738460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHA HEALTH SERVICES NC, LLC

Provider Business Mailing Address
First Line	:	1819 PEACHTREE RD NE
Second Line	:	STE 450
City	:	ATLANTA
State	:	GA
Zip	:	30309-1848
Country	:	US
Telephone Number	:	404-364-2900
Fax Number	:	404-364-2901

Provider Business Practice Location Address
First Line	:	3829 NEVIN RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4357
Country	:	US
Telephone Number	:	704-596-7592
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	JENNIFER D LOZANO
Credential	:
Telephone Number	:	404-968-2663

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	09/19/2015

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