Provider Demographics
NPI:1689725640
Name:EAGLE HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:EAGLE HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-884-4337
Mailing Address - Street 1:8900 SW 24TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2075
Mailing Address - Country:US
Mailing Address - Phone:305-884-4337
Mailing Address - Fax:305-884-4937
Practice Address - Street 1:8900 SW 24TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2075
Practice Address - Country:US
Practice Address - Phone:305-884-4337
Practice Address - Fax:305-884-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20314096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650985101Medicaid
FL650985100Medicaid
FL109339OtherMEDICARE