Provider Demographics
NPI:1235334087
Name:EAGLE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:EAGLE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-872-7686
Mailing Address - Street 1:4428 LOUISBURG RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4302
Mailing Address - Country:US
Mailing Address - Phone:919-872-7686
Mailing Address - Fax:919-872-7456
Practice Address - Street 1:4428 LOUISBURG RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4302
Practice Address - Country:US
Practice Address - Phone:919-872-7686
Practice Address - Fax:919-872-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1628251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600568Medicaid