Provider Demographics
NPI:1760664627
Name:EAGLE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:EAGLE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORNEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-383-2417
Mailing Address - Street 1:5801 PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1021
Mailing Address - Country:US
Mailing Address - Phone:314-383-2417
Mailing Address - Fax:314-383-2417
Practice Address - Street 1:5801 PARK LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1021
Practice Address - Country:US
Practice Address - Phone:314-383-2417
Practice Address - Fax:314-383-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0006559374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty