MEDICARE: EAGLE CASE MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1154742567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE CASE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	7405 N CONGRESS AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64152-2332
Country	:	US
Telephone Number	:	816-746-6556
Fax Number	:	816-756-6353

Provider Business Practice Location Address
First Line	:	7735 WASHINGTON AVE
Second Line	:	SUITE C
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2444
Country	:	US
Telephone Number	:	816-746-6556
Fax Number	:	816-746-6353

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PATRICK O NWANGUZO
Credential	:
Telephone Number	:	913-334-9035

Provider Enumeration Date	:	01/02/2014
Last Update Date	:	01/06/2014

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