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

General Provider Information

NPI Number	:	1972884609
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	:	234 SCOTTS CREEK RD
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-2342
Country	:	US
Telephone Number	:	704-878-6155
Fax Number	:	704-872-3651

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	JENNIFER D LOZANO
Credential	:	MBA
Telephone Number	:	404-364-2900

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	09/16/2015

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