Provider Demographics
NPI:1417157843
Name:EAGLE MEDICAL SERVICES , LLC
Entity Type:Organization
Organization Name:EAGLE MEDICAL SERVICES , LLC
Other - Org Name:EAGLE HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-889-9220
Mailing Address - Street 1:11916 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111
Mailing Address - Country:US
Mailing Address - Phone:216-889-9220
Mailing Address - Fax:216-889-9221
Practice Address - Street 1:11916 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111
Practice Address - Country:US
Practice Address - Phone:216-889-9220
Practice Address - Fax:216-889-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH36-8186251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH368186Medicare Oscar/Certification