Provider Demographics
NPI:1295424075
Name:EAGLE THERAPEUTIC SERVICES PLLC
Entity type:Organization
Organization Name:EAGLE THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-643-1148
Mailing Address - Street 1:677 NANNYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9003
Mailing Address - Country:US
Mailing Address - Phone:336-772-5711
Mailing Address - Fax:704-582-6015
Practice Address - Street 1:8815 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4100
Practice Address - Country:US
Practice Address - Phone:980-643-1148
Practice Address - Fax:704-582-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health