Provider Demographics
NPI:1023413051
Name:EAGLE RISING HEALTH SERVICES
Entity type:Organization
Organization Name:EAGLE RISING HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-574-2129
Mailing Address - Street 1:913 ANN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3003
Mailing Address - Country:US
Mailing Address - Phone:704-574-2129
Mailing Address - Fax:
Practice Address - Street 1:1025 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4356
Practice Address - Country:US
Practice Address - Phone:704-574-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101599363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty