Healthcare Provider Details

I. General information

NPI: 1588751697
Provider Name (Legal Business Name): EAGLE HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 11TH ST
CLARKSTON WA
99403-2815
US

IV. Provider business mailing address

12015 115TH AVE NE #E195
KIRKLAND WA
98034
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-2523
  • Fax: 509-751-9427
Mailing address:
  • Phone: 425-285-3891
  • Fax: 425-285-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1137
License Number StateWA

VIII. Authorized Official

Name: CURRAN WONG
Title or Position: CORPORATE SERVICES
Credential:
Phone: 425-285-3886