=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215069646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RHA HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 09/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2023 S 17TH ST 1B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-763-5355
-----------------------------------------------------
Fax | 910-763-5340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1819 PEACHTREE RD NE STE 450
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-364-2900
-----------------------------------------------------
Fax | 404-364-2901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JENNIFER D LOZANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-364-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------