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General NPI Number Information
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NPI Number | 1326313537
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Entity Type | Organization
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Legal Business Name | MOUNT EAGLE HEALTH CARE
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 470 W HANES MILL RD STE 109
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City | WINSTON SALEM
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State | NC
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Zip | 27105-9102
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Country | US
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Telephone | 336-776-0357
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Fax | 336-499-2002
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Provider Business Mailing Address
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Address Line | 470 W HANES MILL RD STE 105
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City | WINSTON SALEM
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State | NC
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Zip | 27105-9102
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Country | US
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Telephone | 336-776-0357
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Fax | 336-499-2002
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DOROTHY EDWARD MMANYWA
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Credential | RN, MSN
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Telephone | 336-776-8601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC3525
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | HC3525
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License Number State | NC
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