Healthcare Provider Details

I. General information

NPI: 1750348538
Provider Name (Legal Business Name): ROBESON HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E WARDELL DR
PEMBROKE NC
28372
US

IV. Provider business mailing address

60 COMMERCE PLZ
PEMBROKE NC
28372-7386
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-2816
  • Fax: 910-521-3583
Mailing address:
  • Phone: 910-521-2900
  • Fax: 910-775-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMHL-078-064
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6005794
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier344568 A/C
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: GEORGE TIMOTHY HALL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 910-521-2900