NPIMap

Organization Active NPI

Rha Health Services NC, LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Creedmoor, NC
National Provider Identifier
1760527238
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
RHA HEALTH SERVICES NC, LLC
Practice address
105 Park Ave
Creedmoor, NC 27522-9751
Phone
(919) 528-2558
Fax
(919) 528-2971
NPI assigned
Feb 21, 2007
Last updated
Sep 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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

Authorized official

Name
Jennifer D Lozano
Title
Director of Revenue Cycle
Phone
(404) 364-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

105 Park Ave
Creedmoor, NC 27522-9751

Mailing address

1819 Peachtree Rd NE
Ste 450
Atlanta, GA 30309-1848
Phone (404) 364-2900

Other identifiers 1

IdentifierTypeStateIssuer
3416574MedicaidNC

Other names 1

  • PARK AVENUE Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760527238. Details of each certification follow.

  • CCN 34G145 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G145

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PARK AVENUE HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 6, 1990
Last certification
Mar 25, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
105 Park Avenue
Creedmoor, NC 27522

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2166813Rha Health Services105 Park Avenue, Creedmoor, NC 27522Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Rha Health Services NC LLC351 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

105 Park Ave
Creedmoor, NC 27522

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442361600000",
    "number": "1760527238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 PEACHTREE RD NE",
            "address_2": "STE 450",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091848",
            "telephone_number": "404-364-2900",
            "fax_number": "404-364-2901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PARK AVE",
            "city": "CREEDMOOR",
            "state": "NC",
            "postal_code": "275229751",
            "telephone_number": "919-528-2558",
            "fax_number": "919-528-2971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RHA HEALTH SERVICES NC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2015-09-16",
        "status": "A",
        "authorized_official_last_name": "LOZANO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "404-364-2900"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416574",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK AVENUE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Creedmoor, NC

Sources for this page

Verify at the official NPI Registry.