Provider Demographics
NPI:1245468727
Name:EAK GOOD NEIGHBOR PROPERTIES
Entity type:Organization
Organization Name:EAK GOOD NEIGHBOR PROPERTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-524-2400
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0040
Mailing Address - Country:US
Mailing Address - Phone:903-524-2400
Mailing Address - Fax:903-524-2500
Practice Address - Street 1:10 CR NE 2070
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457
Practice Address - Country:US
Practice Address - Phone:903-524-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251X00000XAgenciesSupports Brokerage
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206582301Medicaid