Basic Information
| Provider Information | |||||||||
| NPI: | 1538684212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAGLE ACQUISITION VI LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONCORDIA TRANSITIONAL CARE AND REHABILITATION - ELIZABETH CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 S HALSTEAD BLVD. | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279096920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523380137 | ||||||||
| FaxNumber: | 2523383459 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 S HALSTEAD BLVD. | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279096920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523380137 | ||||||||
| FaxNumber: | 2523383459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | PHILIPSON | ||||||||
| AuthorizedOfficialFirstName: | BENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5168693700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.