MEDICARE: UMOJA BEHAVIORAL HEALTH CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization		NC

General Provider Information

NPI Number	:	1942483193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMOJA BEHAVIORAL HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	108 TUCKASEEGE RD
Second Line	:
City	:	MT HOLLY
State	:	NC
Zip	:	28120-1948
Country	:	US
Telephone Number	:	770-912-4814
Fax Number	:	478-285-4575

Provider Business Practice Location Address
First Line	:	108 TUCKASEEGE RD
Second Line	:
City	:	MT HOLLY
State	:	NC
Zip	:	28120-1948
Country	:	US
Telephone Number	:	704-827-1968
Fax Number	:	704-827-1970

Authorized Official
Title or Position	:	CEO
Name	:	MS. LILLENE NATHAN
Credential	:
Telephone Number	:	770-912-4814

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	02/12/2008

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