Provider Demographics
NPI:1043410004
Name:EAGLE UNIVERSAL LLC
Entity Type:Organization
Organization Name:EAGLE UNIVERSAL LLC
Other - Org Name:EAGLE UNIVERSAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:OSAWARU
Authorized Official - Last Name:OSAKUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-982-9567
Mailing Address - Street 1:88 W 9TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5903
Mailing Address - Country:US
Mailing Address - Phone:909-982-9567
Mailing Address - Fax:
Practice Address - Street 1:88 W 9TH ST APT 9
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5903
Practice Address - Country:US
Practice Address - Phone:909-982-9567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)