Healthcare Provider Details

I. General information

NPI: 1508474529
Provider Name (Legal Business Name): EAGLE GLOBAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43211 DALCOMA DR
CLINTON TWP MI
48038-6309
US

IV. Provider business mailing address

43211 DALCOMA DR
CLINTON TWP MI
48038-6309
US

V. Phone/Fax

Practice location:
  • Phone: 586-623-7025
  • Fax:
Mailing address:
  • Phone: 586-623-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN MOORE
Title or Position: HUMAN RESOURCE ADMIN.
Credential:
Phone: 586-623-7025