Organization Name: | EAGLE RISING HEALTH SERVICES |
NPI Number: | 1023413051 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES HUSON (MEMBER) |
Mailing Address: | 1025 Rockingham Rd Rockingham |
State: | NC US |
Postal Code: | 283794356 |
Phone Number: | 7045742129 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2014 |
NPI Last Update Date: | 11/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 101599 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |