Healthcare Provider Details

I. General information

NPI: 1457998627
Provider Name (Legal Business Name): RE HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 GROVES ST
KINGS MOUNTAIN NC
28086-2232
US

IV. Provider business mailing address

10008 CASA NUESTRA DR
CHARLOTTE NC
28214-2378
US

V. Phone/Fax

Practice location:
  • Phone: 704-778-5635
  • Fax:
Mailing address:
  • Phone: 704-965-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RASHAAD WOODS
Title or Position: MANAGING MEMBER
Credential:
Phone: 704-965-8842