Provider Demographics
NPI:1316382450
Name:EAGLE HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:EAGLE HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:B
Authorized Official - Last Name:FAGBEYIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-522-1248
Mailing Address - Street 1:2516 WAYNE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7883
Mailing Address - Country:US
Mailing Address - Phone:972-522-1248
Mailing Address - Fax:
Practice Address - Street 1:2516 WAYNE WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7883
Practice Address - Country:US
Practice Address - Phone:972-522-1248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011305251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health