Provider Demographics
NPI:1700835048
Name:EAGLE REHABILITATION, LLC
Entity Type:Organization
Organization Name:EAGLE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-581-3000
Mailing Address - Street 1:222 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2821
Mailing Address - Country:US
Mailing Address - Phone:573-581-3000
Mailing Address - Fax:
Practice Address - Street 1:222 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2821
Practice Address - Country:US
Practice Address - Phone:573-581-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty