Basic Information
Provider Information | |||||||||
NPI: | 1750578167 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RVHI,LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HAMPTON MANOR | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2568 | ||||||||
Address2: |   | ||||||||
City: | HICKORY | ||||||||
State: | NC | ||||||||
PostalCode: | 286032568 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8283225535 | ||||||||
FaxNumber: | 8283223897 | ||||||||
Practice Location | |||||||||
Address1: | 320 BROUGHTON ST | ||||||||
Address2: |   | ||||||||
City: | GASTON | ||||||||
State: | NC | ||||||||
PostalCode: | 278329638 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2525330007 | ||||||||
FaxNumber: | 2525330452 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/29/2007 | ||||||||
LastUpdateDate: | 10/04/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TREFZGER | ||||||||
AuthorizedOfficialFirstName: | CHARLES | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8283225535 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/04/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X |   |   | N |   | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 343900000X |   |   | N |   | Transportation Services | Non-emergency Medical Transport (VAN) |   | 310400000X | HAL-066-012 | NC | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
ID Information
ID | Type | State | Issuer | Description | 7805885 | 05 | NC |   | MEDICAID |