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General NPI Number Information
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NPI Number | 1386996072
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Entity Type | Organization
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Legal Business Name | EAGLE EYE HOME SERVICES, INC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1030 S LA GRANGE RD SUITE 29
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City | LA GRANGE
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State | IL
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Zip | 60525-2800
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Country | US
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Telephone | 708-261-0080
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Fax | 708-261-0081
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Provider Business Mailing Address
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Address Line | 1030 S LA GRANGE RD SUITE 29
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City | LA GRANGE
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State | IL
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Zip | 60525-2800
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Country | US
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Telephone | 708-261-0080
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Fax | 708-261-0081
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRYAN JOHN ROMANE
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Credential |
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Telephone | 708-261-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000937
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License Number State | IL
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