Provider Demographics
NPI:1467414904
Name:AMERICAN EAGLE HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:AMERICAN EAGLE HEALTH CARE SERVICES INC
Other - Org Name:CARDINAL WOODS SKILLED NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA; RN
Authorized Official - Phone:440-428-5103
Mailing Address - Street 1:6831 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2255
Mailing Address - Country:US
Mailing Address - Phone:440-428-5103
Mailing Address - Fax:440-428-9003
Practice Address - Street 1:6831 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2255
Practice Address - Country:US
Practice Address - Phone:440-428-5103
Practice Address - Fax:440-428-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3608314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2397562Medicaid
OH=========-00OtherOHIO BWC
OH=========-00OtherOHIO BWC
OH2397562Medicaid