Basic Information
| Provider Information | |||||||||
| NPI: | 1558496059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RHA HEALTH SERVICES NC, LLC | ||||||||
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| OtherOrganizationName: | PATRIOT LANE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 PEACHTREE RD NE | ||||||||
| Address2: | STE 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: | 7048642347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 07/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | LOZANO | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4043642900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7805592 | 05 | NC | MEDICAID |