| Organization Name: | MOUNT EAGLE HEALTH CARE - CLEMMONS, LLC |
| NPI Number: | 1043683188 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BAHATI N SIMTAJI (DIRECTOR) |
| Mailing Address: | 2554 Lewisville Clemmons Rd # 306 Clemmons |
| State: | NC US |
| Postal Code: | 270128110 |
| Phone Number: | 3369344227 |
| Fax Number: | |
| NPI Enumeration Date: | 11/12/2015 |
| NPI Last Update Date: | 11/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | HC1587 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |