Provider Demographics
NPI:1477021616
Name:EAGLES EYE COMFORT CARE MIRAMAR
Entity Type:Organization
Organization Name:EAGLES EYE COMFORT CARE MIRAMAR
Other - Org Name:EAGLES EYE COMFORT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUMPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-232-1389
Mailing Address - Street 1:6308 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3920
Mailing Address - Country:US
Mailing Address - Phone:954-232-1389
Mailing Address - Fax:
Practice Address - Street 1:8620 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6567
Practice Address - Country:US
Practice Address - Phone:954-232-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033628730Medicaid
FL022883500Medicaid