Healthcare Provider Details

I. General information

NPI: 1609247634
Provider Name (Legal Business Name): MOUNT EAGLE HEALTH CARE-THOMASVILLE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 W MAIN ST SUITE 203
THOMASVILLE NC
27360-3935
US

IV. Provider business mailing address

14 W MAIN ST SUITE 203
THOMASVILLE NC
27360-3935
US

V. Phone/Fax

Practice location:
  • Phone: 336-287-6169
  • Fax:
Mailing address:
  • Phone: 336-287-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4420
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHC4420
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC4420
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberHC4420
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4420
License Number StateNC

VIII. Authorized Official

Name: WEMA SALOME CHAGULA
Title or Position: MEMBER,OWNER
Credential:
Phone: 336-287-6169