Provider Demographics
NPI:1477552974
Name:AMERICAN EAGLE NURSING HOME OF WHITEHOUSE, LLC
Entity Type:Organization
Organization Name:AMERICAN EAGLE NURSING HOME OF WHITEHOUSE, LLC
Other - Org Name:OAKBROOK HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BURFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-839-5050
Mailing Address - Street 1:107 STACY DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3740
Mailing Address - Country:US
Mailing Address - Phone:903-839-5050
Mailing Address - Fax:903-839-8461
Practice Address - Street 1:107 STACY DR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3740
Practice Address - Country:US
Practice Address - Phone:903-839-5050
Practice Address - Fax:903-839-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX525003Medicaid
TX525003Medicaid