MEDICARE: EAGLE HOME HEALTH AGENCY INC

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	H14-00396	NV

General Provider Information

NPI Number	:	1619355047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE HOME HEALTH AGENCY INC

Provider Business Mailing Address
First Line	:	222 S RAINBOW BLVD
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-242-4242
Fax Number	:	702-242-4243

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-242-4242
Fax Number	:	702-242-4243

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HELEN AUSTIN
Credential	:	RN
Telephone Number	:	702-242-4242

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	05/18/2015

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