Provider Demographics
NPI:1578328811
Name:EAGLE CAP COFFEE LLC
Entity Type:Organization
Organization Name:EAGLE CAP COFFEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-539-9536
Mailing Address - Street 1:30 S LOUISIANA ST STE 211
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9003
Mailing Address - Country:US
Mailing Address - Phone:509-572-3972
Mailing Address - Fax:509-572-3968
Practice Address - Street 1:30 S LOUISIANA ST STE 211
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9003
Practice Address - Country:US
Practice Address - Phone:509-572-3972
Practice Address - Fax:509-572-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care