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General NPI Number Information
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NPI Number | 1356911465
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Entity Type | Organization
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Legal Business Name | EAGLE BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 1007 N FRONT ST STE 2S
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City | HARRISBURG
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State | PA
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Zip | 17102-3320
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Country | US
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Telephone | 717-973-1108
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Fax | 717-674-7696
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Provider Business Mailing Address
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Address Line | 1007 N FRONT ST STE 2S
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City | HARRISBURG
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State | PA
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Zip | 17102-3320
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Country | US
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Telephone | 717-973-1108
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Fax | 717-674-7696
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | THERESA N ADIGWU
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Credential | CRNP
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Telephone | 717-973-1108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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