Provider Demographics
NPI:1255111597
Name:EMINENT RESOUCES LLC
Entity type:Organization
Organization Name:EMINENT RESOUCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MANWOR
Authorized Official - Last Name:AGUENE
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:404-519-7340
Mailing Address - Street 1:2930 DUNLIN LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7805
Mailing Address - Country:US
Mailing Address - Phone:404-519-7340
Mailing Address - Fax:
Practice Address - Street 1:2930 DUNLIN LAKE WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7805
Practice Address - Country:US
Practice Address - Phone:404-519-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care