Provider Demographics
NPI:1114278280
Name:EAGLE'S HEALING NEST
Entity Type:Organization
Organization Name:EAGLE'S HEALING NEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-371-1570
Mailing Address - Street 1:310 HIGHWAY 71 N.
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378
Mailing Address - Country:US
Mailing Address - Phone:320-351-6200
Mailing Address - Fax:320-351-6202
Practice Address - Street 1:310 HIGHWAY 71 N.
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378
Practice Address - Country:US
Practice Address - Phone:320-351-6200
Practice Address - Fax:320-351-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5381251K00000X
MN5382251K00000X
MN5380251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare