Healthcare Provider Details

I. General information

NPI: 1720598931
Provider Name (Legal Business Name): EAGLE NURSING & HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BUENA VISTA AVE
LANHAM MD
20706-3006
US

IV. Provider business mailing address

4259 58TH AVE APT 4
BLADENSBURG MD
20710-1925
US

V. Phone/Fax

Practice location:
  • Phone: 240-393-6752
  • Fax:
Mailing address:
  • Phone: 240-393-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR4116
License Number StateMD

VIII. Authorized Official

Name: ANTHONY OKENWA
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-393-6752