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General NPI Number Information
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NPI Number | 1588751697
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Entity Type | Organization
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Legal Business Name | EAGLE HEALTHCARE, INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 1242 11TH ST
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City | CLARKSTON
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State | WA
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Zip | 99403-2815
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Country | US
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Telephone | 509-758-2523
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Fax | 509-751-9427
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Provider Business Mailing Address
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Address Line | 12015 115TH AVE NE #E195
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City | KIRKLAND
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State | WA
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Zip | 98034
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Country | US
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Telephone | 425-285-3891
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Fax | 425-285-3899
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Authorized Official
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Title or Position | CORPORATE SERVICES
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Name | CURRAN WONG
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Credential |
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Telephone | 425-285-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1137
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License Number State | WA
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