Provider Demographics
NPI:1538298153
Name:EAGLE HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:EAGLE HEALTHCARE SERVICES INC.
Other - Org Name:EAGLE PSR
Other - Org Type:Doing Business As
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:
Authorized Official - Phone:919-872-7686
Mailing Address - Street 1:1708 TRAWICK RD
Mailing Address - Street 2:115
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3897
Mailing Address - Country:US
Mailing Address - Phone:919-872-7686
Mailing Address - Fax:919-872-7456
Practice Address - Street 1:1708 TRAWICK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2180
Practice Address - Country:US
Practice Address - Phone:919-872-7686
Practice Address - Fax:919-872-7456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTHCARE SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1628251E00000X
251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803989Medicaid
NC7805338Medicaid
NC7804863Medicaid
NC7805144Medicaid
NC8301237Medicaid
NC7805026Medicaid
NC7804642Medicaid
NC7805338Medicaid