Provider Demographics
NPI:1326313537
Name:MOUNT EAGLE HEALTH CARE
Entity Type:Organization
Organization Name:MOUNT EAGLE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MMANYWA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:336-776-8601
Mailing Address - Street 1:470 W HANES MILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9102
Mailing Address - Country:US
Mailing Address - Phone:336-776-0357
Mailing Address - Fax:336-499-2002
Practice Address - Street 1:470 W HANES MILL RD STE 109
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9102
Practice Address - Country:US
Practice Address - Phone:336-776-0357
Practice Address - Fax:336-499-2002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT EAGLE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3525251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health