Organization
EAGLE HOME 4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY NWANKWO RN (ADMINISTRATOR)
(919) 872-7686
Entity
Organization
Contact information
Practice address
101 N PEARTREE LN, RALEIGH, NC 27610-1823
(919) 212-1658
(919) 212-1658
Mailing address
101 N PEARTREE LN, RALEIGH, NC 27610-1823
(919) 212-1658
(919) 212-1658
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
MHL09237
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805026
—
NC
Enumeration date
03/29/2007
Last updated
08/22/2020
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