Provider Demographics
NPI:1083381297
Name:EAGLE THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:EAGLE THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:980-643-1148
Mailing Address - Street 1:677 NANNYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9003
Mailing Address - Country:US
Mailing Address - Phone:336-772-5711
Mailing Address - Fax:
Practice Address - Street 1:1565 EBENEZER RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2494
Practice Address - Country:US
Practice Address - Phone:980-643-1148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)