Provider Demographics
NPI:1174754808
Name:EAGLES UNLIMITED
Entity type:Organization
Organization Name:EAGLES UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-254-7600
Mailing Address - Street 1:PO BOX 27302
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7302
Mailing Address - Country:US
Mailing Address - Phone:505-254-7600
Mailing Address - Fax:505-254-7707
Practice Address - Street 1:1020 5TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2141
Practice Address - Country:US
Practice Address - Phone:505-254-7600
Practice Address - Fax:505-254-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty