Healthcare Provider Details

I. General information

NPI: 1376812891
Provider Name (Legal Business Name): ROBESON HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 BURNS RD
LUMBERTON NC
28358-9116
US

IV. Provider business mailing address

60 COMMERCE PLZ
PEMBROKE NC
28372-7386
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-5545
  • Fax: 910-738-5565
Mailing address:
  • Phone: 910-521-2900
  • Fax: 910-775-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-078-283
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-078-283
License Number StateNC

VIII. Authorized Official

Name: TIM HALL
Title or Position: PRESIDENT & CEO
Credential: M.DIV., LCAS, CCS
Phone: 910-521-2900