MEDICARE: UMOJA BEHAVIORAL HEALTH CARE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1689900235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMOJA BEHAVIORAL HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	2120 SPRINGS ST
Second Line	:	SUITE B
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2198
Country	:	US
Telephone Number	:	704-605-8608
Fax Number	:	704-820-6506

Provider Business Practice Location Address
First Line	:	2120 SPRINGS ST
Second Line	:	SUITE B
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2198
Country	:	US
Telephone Number	:	704-605-8608
Fax Number	:	704-820-6506

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LILLENE NATHAN
Credential	:
Telephone Number	:	704-605-8608

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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