1770646408 NPI number — RHA HEALTH SERVICES NC, LLC

Table of content: (NPI 1770646408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770646408 NPI number — RHA HEALTH SERVICES NC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHA HEALTH SERVICES NC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770646408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1819 PEACHTREE RD NE
Provider Second Line Business Mailing Address:
STE 450
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-364-2900
Provider Business Mailing Address Fax Number:
404-364-2901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2524 SHELBURNE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28227-9554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-545-7075
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOZANO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
404-968-2663

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  MHL-060-390 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X , with the licence number: MHL-060-390 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3426140 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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