Healthcare Provider Details

I. General information

NPI: 1689738460
Provider Name (Legal Business Name): RHA HEALTH SERVICES NC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 NEVIN RD
CHARLOTTE NC
28269-4357
US

IV. Provider business mailing address

1819 PEACHTREE RD NE STE 450
ATLANTA GA
30309-1848
US

V. Phone/Fax

Practice location:
  • Phone: 704-596-7592
  • Fax:
Mailing address:
  • Phone: 404-364-2900
  • Fax: 404-364-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-060-139
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-060-139
License Number StateNC

VIII. Authorized Official

Name: JENNIFER D LOZANO
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 404-968-2663