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General NPI Number Information
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NPI Number | 1891997854
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Entity Type | Organization
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Legal Business Name | EAGLES HEALTH AND WELLNESS LLC,
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1308 ROSE BLVD STE A
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City | ORLANDO
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State | FL
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Zip | 32839-3385
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Country | US
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Telephone | 407-822-1107
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Fax | 407-822-1108
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Provider Business Mailing Address
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Address Line | 1308 ROSE BLVD STE A
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City | ORLANDO
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State | FL
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Zip | 32839-3385
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Country | US
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Telephone | 407-822-1107
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Fax | 407-822-1108
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CLAIRE ROSE CIMERVIL SR.
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Credential | P
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Telephone | 407-822-1107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC7645
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License Number State | FL
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