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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