Basic Information
Provider Information
NPI: 1184002768
EntityType: 2
ReplacementNPI:  
OrganizationName: RHA HEALTH SERVICES NC, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CAPE FEAR RESPITE HOME
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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: 4403 BRIDGES VIEW RD
Address2:  
City: MORGANTON
State: NC
PostalCode: 286555809
CountryCode: US
TelephoneNumber: 8008480180
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2015
LastUpdateDate: 01/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LOZANO
AuthorizedOfficialFirstName: JENNIFER
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR OF REVENUE CYCLE
AuthorizedOfficialTelephone: 4049682663
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MBA, CPC-P
NPICertificationDate: 01/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
385H00000X  N Respite Care FacilityRespite Care 
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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