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NPI Code Detail

MEDICARE: AMERICAN EAGLE NURSING HOME OF WHITEHOUSE, LLC

MEDICARE: AMERICAN EAGLE NURSING HOME OF WHITEHOUSE, 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477552974
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMERICAN EAGLE NURSING HOME OF WHITEHOUSE, LLC
Provider Business Mailing Address
First Line : 107 STACY DR
Second Line :
City : WHITEHOUSE
State : TX
Zip : 75791-3740
Country : US
Telephone Number : 903-839-5050
Fax Number : 903-839-8461
Provider Business Practice Location Address
First Line : 107 STACY DR
Second Line :
City : WHITEHOUSE
State : TX
Zip : 75791-3740
Country : US
Telephone Number : 903-839-5050
Fax Number : 903-839-8461
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. VIRGINIA SUE BURFORD
Credential :
Telephone Number : 903-839-5050
Provider Enumeration Date : 07/18/2005
Last Update Date : 08/22/2020

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Directions to “AMERICAN EAGLE NURSING HOME OF WHITEHOUSE, LLC ” Practice Location

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