Provider Demographics
NPI:1609247634
Name:MOUNT EAGLE HEALTH CARE-THOMASVILLE,LLC
Entity Type:Organization
Organization Name:MOUNT EAGLE HEALTH CARE-THOMASVILLE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WEMA
Authorized Official - Middle Name:SALOME
Authorized Official - Last Name:CHAGULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-287-6169
Mailing Address - Street 1:14 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3935
Mailing Address - Country:US
Mailing Address - Phone:336-287-6169
Mailing Address - Fax:
Practice Address - Street 1:14 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3935
Practice Address - Country:US
Practice Address - Phone:336-287-6169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4420251E00000X, 251F00000X, 251J00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care