Provider Demographics
NPI:1265996466
Name:EAGLE HOME CARE LLC
Entity type:Organization
Organization Name:EAGLE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-316-9200
Mailing Address - Street 1:8655 BELFORD AVE APT 123
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8630
Mailing Address - Country:US
Mailing Address - Phone:310-316-9200
Mailing Address - Fax:310-329-1213
Practice Address - Street 1:8655 BELFORD AVE APT 123
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-8630
Practice Address - Country:US
Practice Address - Phone:310-316-9200
Practice Address - Fax:310-329-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY2888783OtherPERSONAL CARE AGENCY