NPIMap

Organization Active NPI

Eagle Peak LTC Group, LLC

Doing business as Kerr Lake Nursing and Rehabilitation Center

  • Nursing Facility/Intermediate Care Facility
  • Henderson, NC
National Provider Identifier
1669657755
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
NH0353 Issued in NC
Legal business name
EAGLE PEAK LTC GROUP, LLC
Doing business as
Kerr Lake Nursing and Rehabilitation Center
Practice address
1245 Park Ave
Henderson, NC 27536-4025
Phone
(252) 492-7021
Fax
(252) 492-2985
NPI assigned
Jan 8, 2008
Last updated
Aug 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Mr. Norwood Randolph Uzzell
Title
President
Phone
(252) 523-9094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH0353 NC Primary

Addresses

Primary practice location

1245 Park Ave
Henderson, NC 27536-4025

Mailing address

PO Box 1148
Henderson, NC 27536-1148
Phone (252) 492-7021

Other identifiers 2

IdentifierTypeStateIssuer
7803814MedicaidNC
7806629MedicaidNC

Other names 1

  • Kerr Lake Nursing and Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

National Provider Directory

National Provider Directory
Tax ID family
Ability Network4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1669657755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1148",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275361148",
            "telephone_number": "252-492-7021",
            "fax_number": "252-492-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 PARK AVE",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364025",
            "telephone_number": "252-492-7021",
            "fax_number": "252-492-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE PEAK LTC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2022-08-12",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "UZZELL",
        "authorized_official_first_name": "NORWOOD",
        "authorized_official_middle_name": "RANDOLPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-523-9094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "NH0353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803814",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806629",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kerr Lake Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kerr Lake Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; 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.