Healthcare Provider Details

I. General information

NPI: 1578616041
Provider Name (Legal Business Name): EAGLE HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 HILLCREST AVE
GRANDVIEW WA
98930-1441
US

IV. Provider business mailing address

12015 115TH AVE NE # E195
KIRKLAND WA
98034-6940
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-1200
  • Fax: 509-882-5161
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 Number1118
License Number StateWA

VIII. Authorized Official

Name: MR. GREG SCHMIDT
Title or Position: CONTROLLER
Credential:
Phone: 425-285-3891