EAGLE PEAK LTC GROUP, LLC (NPI# 1669657755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669657755 |
| Entity Type | Organization |
| Organization Name | EAGLE PEAK LTC GROUP, LLC |
| Other Organization Name | KERR LAKE NURSING AND REHABILITATION CENTER |
| Practice Address |
1245 Park Ave Henderson NC 27536-4025 |
| Mailing Address |
Po Box 1148 Henderson NC 27536-1148 |
| Practice Telephone | 2524927021 |
| Practice Fax Number | 2524922985 |
| Mailing Telephone | 2524927021 |
| Mailing Fax Number | 2524922985 |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2012-05-09 |
| Authorized Official Name | MR. NORWOOD RANDOLPH UZZELL (PRESIDENT) |
| Authorized Official Telephone | 2525239094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | NH0353 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7803814 | 05 | |
| NC | 7806629 | 05 |
| Other Name | Type Code |
|---|---|
| Kerr Lake Nursing and Rehabilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376570275 | Eagle Peak Ltc Group, LLC | Skilled Nursing Facility | 1704 Nc Hwy 39 North, Louisburg, NC 27549 | 2006-06-27 |
| 1821024274 | Eagle Peak Ltc Group, LLC | Skilled Nursing Facility | 208 Cary St, Enfield, NC 27823-1204 | 2006-06-25 |
| 1184650541 | Eagle Peak Ltc Group, LLC | Skilled Nursing Facility | 1016 Fletcher St, Wilkesboro, NC 28697-9472 | 2006-06-25 |
| 1972547321 | Eagle Peak Ltc Group, LLC | Skilled Nursing Facility | 1245 Park Ave, Henderson, NC 27536-4025 | 2006-06-16 |
| Street Address |
1245 PARK AVE |
| City | HENDERSON |
| State | NC |
| Zip Code | 27536-4025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972547321 | Eagle Peak Ltc Group, LLC | Skilled Nursing Facility | 1245 Park Ave, Henderson, NC 27536-4025 | 2006-06-16 |
| 1750840245 | Meghan Ealy | Occupational Therapist | 1245 Park Ave, Henderson, NC 27536-4025 | 2019-03-14 |
| 1992271704 | Katherine Ingram | Speech-Language Pathologist | 1245 Park Ave, Henderson, NC 27536-4025 | 2018-10-18 |
| 1245711969 | Ashlea Soemo | Speech-Language Pathologist | 1245 Park Ave, Henderson, NC 27536-4025 | 2018-08-22 |
| 1558849778 | Jessica Combs | Physical Therapy Assistant | 1245 Park Ave, Henderson, NC 27536-4025 | 2018-07-31 |
| 1578051298 | Mansi Shah | Physical Therapist | 1245 Park Ave, Henderson, NC 27536-4025 | 2018-04-27 |
| 1134316565 | Britthaven, Inc. | Nursing Facility/Intermediate Care Facility | 1245 Park Ave, Henderson, NC 27536-4025 | 2007-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952940926 | Lane and Associates Xxxvi Dds Pa | Dentist | 900 South Garnett St., Henderson, NC 27536 | 2019-12-23 |
| 1487012076 | Melissa Burroughs | Registered Nurse | 943-h W. Andrews Avenue, Henderson, NC 27536 | 2016-02-10 |
| 1578949269 | Growth Recovery Opportunity & Wellness | Community/Behavioral Health | 804 South Garnett St, Henderson, NC 27536 | 2015-08-04 |
| 1003290297 | Saintpaulhealthcarept, Inc. | Home Health | 839 E Montgomery St, Henderson, NC 27536 | 2015-07-17 |
| 1518369859 | Kristina Thornton | Pharmacist | 200 North Cooper Road, Henderson, NC 27536 | 2014-09-18 |
| 1306285135 | Green Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 429 Sunnyview Road, Henderson, NC 27536 | 2013-06-14 |
| 1760820278 | Innovative Health Services | In Home Supportive Care | 1758 Parham Street, Henderson, NC 27536 | 2013-06-06 |
| 1578900015 | Frances Veronica Finamore | Counselor | 710 Parham Street, Henderson, NC 27536 | 2013-05-23 |
| 1952530834 | Sucessful Achievements Program Incorporated | Driver | 133 Us 1 A, Norlina, NC 27536 | 2009-07-13 |
| 1407096100 | Recovery Response Center | Psychiatric Hospital | 300 Parkview Drive, Henderson, NC 27536 | 2009-02-20 |
| Find all providers in zip 27536 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194704999 | Henderson County Health Care Corporation | Nursing Facility/Intermediate Care Facility | 851 Kimsey Ln, Henderson, KY 42420-2665 | 2006-01-11 |
| 1922491505 | Parkway Recovery Care Center, LLC | Nursing Facility/Intermediate Care Facility | 100 N Green Valley Pkwy, Suite 330, Henderson, NV 89074-6391 | 2015-03-06 |
| 1134316565 | Britthaven, Inc. | Nursing Facility/Intermediate Care Facility | 1245 Park Ave, Henderson, NC 27536-4025 | 2007-10-01 |
| 1639282312 | Henderson Health Care Services, Inc. | Nursing Facility/Intermediate Care Facility | 1621 Front St, Henderson, NE 68371-8902 | 2006-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841617974 | Christopher Rushmeyer | Nursing Facility/Intermediate Care Facility | 1820 Harris Houston Rd, Unit 621411, Charlotte, NC 28262-9253 | 2014-03-26 |
| 1306284674 | Legacy | Nursing Facility/Intermediate Care Facility | 903 W Main Street, Yadkinville, NC 27055 | 2013-06-10 |
| 1194077024 | Skill Creations | Nursing Facility/Intermediate Care Facility | 2101 Royall Ave, Goldsboro, NC 27534-7408 | 2012-10-02 |
| 1093066375 | Sci-east | Nursing Facility/Intermediate Care Facility | 338 Cooper St, Winterville, NC 28590-9507 | 2012-09-26 |
| 1053662437 | Skill Creations of Clinton | Nursing Facility/Intermediate Care Facility | 223 Forest Trail, Clinton, NC 28328-3353 | 2012-09-26 |
| 1821349101 | Sci-duplin House | Nursing Facility/Intermediate Care Facility | 120 Orville Street, Warsaw, NC 28398-2221 | 2012-09-26 |
| 1801147186 | Skill Creations of Kenansville | Nursing Facility/Intermediate Care Facility | 218 S Stokes Street, Kenansville, NC 28349-0001 | 2012-09-26 |
| 1750632030 | Sci-coastal House I and II | Nursing Facility/Intermediate Care Facility | 1974 W Lakeshore Drive, Wilmington, NC 28401-6856 | 2012-09-26 |
| 1760732994 | Sci-triangle House II | Nursing Facility/Intermediate Care Facility | 1523 Tyonek Dr, Durham, NC 27703-5639 | 2012-09-14 |
| 1275883498 | Skill Creations of Kinston | Nursing Facility/Intermediate Care Facility | 901 Doctors Dr, Kinston, NC 28501-1574 | 2012-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.