Healthcare Provider Details

I. General information

NPI: 1467414904
Provider Name (Legal Business Name): AMERICAN EAGLE HEALTH CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 CHAPEL RD
MADISON OH
44057-2255
US

IV. Provider business mailing address

6831 CHAPEL RD
MADISON OH
44057-2255
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-5103
  • Fax: 440-428-9003
Mailing address:
  • Phone: 440-428-5103
  • Fax: 440-428-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3608
License Number StateOH

VIII. Authorized Official

Name: MS. JOYCE M HUMPHREY
Title or Position: ADMINISTRATOR
Credential: LNHA; RN
Phone: 440-428-5103