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Organization
EAGLE PEAK LTC GROUP, LLC
Active
Organization
EAGLE PEAK LTC GROUP, LLC
Active
Other names
Kerr Lake Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN G MCDANIEL (PRESIDENT)
(252) 523-9094
Entity
Organization
Contact information
Practice address
1245 PARK AVE, HENDERSON, NC 27536-4025
(252) 492-7021
(252) 492-2985
Mailing address
PO BOX 1148, HENDERSON, NC 27536-1148
(252) 492-7021
(252) 492-2985
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0353
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0088D
BC/BS OF NC
NC
05
—
3415321
—
NC
05
—
3425321
—
NC
05
—
7806629
—
NC
Enumeration date
06/16/2006
Last updated
07/16/2021
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