Organization
EAGLES NEST TRUCK STATION INC
Active
Other names
Moss Oaks Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS W PENLEY SR. (CEO)
(706) 855-1773
Entity
Organization
Contact information
Practice address
508 S ROGERS ST, POOLER, GA 31322-3116
(912) 748-6842
(912) 748-5214
Mailing address
PO BOX 929, POOLER, GA 31322-0929
(912) 748-6842
(912) 748-5214
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00238741A
—
GA
01
—
1041060001
DME
—
Enumeration date
08/12/2005
Last updated
08/22/2020
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