Robeson Health Care Corporation
Organization Active NPI Community/Behavioral Health Agency · Pembroke, NC
NPI 1063554004 · NPPES record last updated Jun 28, 2017
Key facts
- NPI
- 1063554004
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- MHL-078-062 (NC)
- Legal business name
- ROBESON HEALTH CARE CORPORATION
- Practice address
- 309 East Wardell Drive
Suite a
Pembroke, NC 28372-7998 - Phone
- (910) 521-1464
- Fax
- (910) 521-1852
- NPI assigned
- Feb 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Tim Hall, M.DIV.
- Title
- Director of Behavioral Health SVCS
- Phone
- (910) 521-2900
Other NPIs on the same Medicare enrollment 15
Corporate family (same tax ID) 15
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031231000292 | NC | Part B Supplier - Clinic/Group Practice | 1850290693 |
Receives reassigned benefits from 27 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Red Springs, NC; Smithfield, NC; Saint Pauls, NC; Pembroke, NC; Maxton, NC; Lumberton, NC; Fairmont, NC; Laurinburg, NC… |
National Provider Directory
- Tax ID family
- Robeson Health Care Corporation
Locations
309 E Wardell Dr
Ste A
Pembroke, NC 28372
Phone (910) 521-1464
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | MHL-078-062 | NC | |
| Community/Behavioral Health Agency | 251S00000X | MHL-078-062 | NC | Yes |
Addresses
Primary practice location
309 East Wardell Drive
Suite a
Pembroke, NC 28372-7998
Mailing address
60 Commerce Plaza Cir
Pembroke, NC 28372-7386
Phone (910) 521-2900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6005789 | Medicaid | NC | |
| 8300812B | Medicaid | NC | |
| 8300812 | Medicaid | NC | |
| 8300812G | Medicaid | NC | |
| 8300812P | Medicaid | NC | |
| 8300812Q | Medicaid | NC |
Other names
- Our House
Other providers in Pembroke, NC
- Adia Resha Redfearn
- Porsha L Revels
- Carlos Miguel Rivera Jr.
- Shana Roark
- Robeson Health Care Corporation
- Robeson Health Care Corporation
- Robeson Health Care Corporation
- Robeson Health Care Corporation
- Latoya Lynn Robinson
- Natalie Grace Rodgers
All providers in Pembroke, NC · Community/Behavioral Health Agency in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.