Healthcare Provider Details

I. General information

NPI: 1609532597
Provider Name (Legal Business Name): EAGLEWINGS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

IV. Provider business mailing address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

V. Phone/Fax

Practice location:
  • Phone: 443-985-5257
  • Fax:
Mailing address:
  • Phone: 443-985-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: NNEKA OLUNWA
Title or Position: OWNER/PRESIDENT/ADMIN
Credential:
Phone: 443-985-5257