Provider Demographics
NPI:1184682973
Name:EAGLE EYE FAMILY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:EAGLE EYE FAMILY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-992-8776
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-0516
Mailing Address - Country:US
Mailing Address - Phone:440-992-8776
Mailing Address - Fax:440-992-8776
Practice Address - Street 1:4515 N RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4364
Practice Address - Country:US
Practice Address - Phone:440-992-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)