Provider Demographics
NPI:1942858212
Name:EAGLE GRACE HEALTH CARE LLC.
Entity Type:Organization
Organization Name:EAGLE GRACE HEALTH CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:TSHIABA
Authorized Official - Last Name:MULUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-485-0109
Mailing Address - Street 1:260 NORTHLAND BLVD STE 114B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3726
Mailing Address - Country:US
Mailing Address - Phone:513-771-0843
Mailing Address - Fax:513-771-0492
Practice Address - Street 1:260 NORTHLAND BLVD STE 114B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3726
Practice Address - Country:US
Practice Address - Phone:513-771-0843
Practice Address - Fax:513-771-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty