Basic Information
| Provider Information | |||||||||
| NPI: | 1013395698 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RHA HEALTH SERVICES NC, LLC | ||||||||
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| OtherOrganizationName: | DEEP GAP VOC CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 PEACHTREE RD NE | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043642900 | ||||||||
| FaxNumber: | 4043642901 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 WILDCAT RD | ||||||||
| Address2: | |||||||||
| City: | DEEP GAP | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286189267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282625450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | LOZANO | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4049682663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA, CPC-P | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.