Provider Demographics
NPI:1962493015
Name:EAGLE HEALTHCARE, INC
Entity Type:Organization
Organization Name:EAGLE HEALTHCARE, INC
Other - Org Name:EAGLE REHABILITATION AT SUNNYSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CURRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-285-3886
Mailing Address - Street 1:12015 115TH AVE NE # E195
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6940
Mailing Address - Country:US
Mailing Address - Phone:425-285-3891
Mailing Address - Fax:
Practice Address - Street 1:721 OTIS AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2328
Practice Address - Country:US
Practice Address - Phone:509-837-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1117314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111175Medicaid
WA505226Medicare Oscar/Certification