Mount Eagle Health Care Greensboro, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

HC4420 Issued in NC

Legal business name

MOUNT EAGLE HEALTH CARE GREENSBORO, LLC

Practice address

1 Centerview Dr Ste 203
Greensboro, NC 27407-3712

Phone

(336) 283-5191

Fax

(336) 499-6532

NPI assigned

Sep 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dorothy Edward Shallua, RN

Title

Director

Phone

(336) 283-5191

Specialties & licenses 5

Addresses

Other names 1

• MOUNT EAGLE HEALTH CARE Former legal business name

Tax ID family

Mount Eagle Health Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mount Eagle Health Care Greensboro, LLC

  • Nursing Care Agency
  • Winston Salem, NC
  • NPI 1760854715
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441152000000",
    "number": "1194192500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CENTERVIEW DR STE 203",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073712",
            "telephone_number": "336-283-5191",
            "fax_number": "336-499-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CENTERVIEW DR STE 203",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073712",
            "telephone_number": "336-283-5191",
            "fax_number": "336-499-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT EAGLE HEALTH CARE GREENSBORO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-02",
        "last_updated": "2015-09-02",
        "status": "A",
        "authorized_official_last_name": "SHALLUA",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-283-5191",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": "HC4420",
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "NC",
            "license": "HC4420",
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NC",
            "license": "HC4420",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "HC4420",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "HC4420",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNT EAGLE HEALTH CARE",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Michelle H Mottinger, DDS
• Komal Motwani
• Gray Sappenfield Moulton, LMFT
• Jahnae Moultrie
• Haley Mound
• Kayla Mounts
• Iradatou Moutari
• Move Forward Physical Therapy & Wellness LLC
• Flavia Mowlanejad
• Moxie Crew LLC

• All providers in Greensboro, NC
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.