Provider Demographics
NPI:1679169270
Name:EAGLE'S NEST HOME CARE LLC
Entity Type:Organization
Organization Name:EAGLE'S NEST HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-200-9394
Mailing Address - Street 1:1 GARRETT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2302
Mailing Address - Country:US
Mailing Address - Phone:610-247-7952
Mailing Address - Fax:610-822-7052
Practice Address - Street 1:1 GARRETT RD STE 1
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2302
Practice Address - Country:US
Practice Address - Phone:610-247-7952
Practice Address - Fax:610-822-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103741483-0001Medicaid