# EAGLE HOME 4

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265552053
- **Authorized official:** ROSEMARY NWANKWO RN (ADMINISTRATOR)
- **Authorized official phone:** (919) 872-7686

## Contact information

- **Practice address:** 101 N PEARTREE LN, RALEIGH, NC 27610-1823
- **Practice address phone:** (919) 212-1658
- **Practice address fax:** (919) 212-1658
- **Mailing address:** 101 N PEARTREE LN, RALEIGH, NC 27610-1823
- **Mailing address phone:** (919) 212-1658
- **Mailing address fax:** (919) 212-1658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | MHL09237 | NC | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805026 | — | NC |