Provider Demographics
NPI:1518954908
Name:EAGLE POINTE, INC
Entity Type:Organization
Organization Name:EAGLE POINTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:317-788-2500
Mailing Address - Street 1:1600 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2815
Mailing Address - Country:US
Mailing Address - Phone:304-485-6476
Mailing Address - Fax:304-485-1306
Practice Address - Street 1:1600 27TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2815
Practice Address - Country:US
Practice Address - Phone:304-485-6476
Practice Address - Fax:304-485-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0003696001Medicaid
WA1213110001OtherDMERC
WA0003696001Medicaid