Provider Demographics
NPI:1710282603
Name:EAGLE HOME CARE, L.L.C.
Entity Type:Organization
Organization Name:EAGLE HOME CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-472-2225
Mailing Address - Street 1:2700 KEITH ST NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3765
Mailing Address - Country:US
Mailing Address - Phone:423-472-2225
Mailing Address - Fax:
Practice Address - Street 1:2700 KEITH ST NW
Practice Address - Street 2:SUITE 3
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3765
Practice Address - Country:US
Practice Address - Phone:423-472-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care