NPIMap

Organization Active NPI

Robeson Health Care Corporation

  • Community/Behavioral Health Agency
  • Greenville, NC
National Provider Identifier
1063554095
Registry record updated Dec 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-074-117 Issued in NC
Legal business name
ROBESON HEALTH CARE CORPORATION
Practice address
3362 Frontgate Dr Apt 11
Greenville, NC 27834-8584
Phone
(252) 752-5555
Fax
(252) 752-5455
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tim Hall, M.DIV.
Title
VP/Chief of Behavorial Health SVCS
Phone
(910) 521-2900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X MHL-074-117 NC
Community/Behavioral Health Agency 251S00000X MHL-074-117 NC Primary

Addresses

Primary practice location

3362 Frontgate Dr Apt 11
Greenville, NC 27834-8584

Mailing address

60 Commerce Plaza Cir
Pembroke, NC 28372-7386
Phone (910) 521-2900

Other identifiers 4

IdentifierTypeStateIssuer
8300615MedicaidNC
8300615PMedicaidNC
6005790MedicaidNC
8300615BMedicaidNC

Other names 1

  • The Village Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544745600000",
    "number": "1063554095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PLAZA CIR",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727386",
            "telephone_number": "910-521-2900",
            "fax_number": "910-775-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3362 FRONTGATE DR APT 11",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278348584",
            "telephone_number": "252-752-5555",
            "fax_number": "252-752-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBESON HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2018-12-14",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "VP/CHIEF OF BEHAVORIAL HEALTH SVCS",
        "authorized_official_telephone_number": "910-521-2900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.DIV."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "MHL-074-117",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-074-117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300615",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300615P",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005790",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300615B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.