Provider Demographics
NPI:1669748802
Name:EAGLE PRIMARY HOME HEALTHCARE INC. AS F/EA
Entity type:Organization
Organization Name:EAGLE PRIMARY HOME HEALTHCARE INC. AS F/EA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:B
Authorized Official - Last Name:FAGBEYIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:972-522-1248
Mailing Address - Street 1:2516 WAYNE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7883
Mailing Address - Country:US
Mailing Address - Phone:972-522-1248
Mailing Address - Fax:972-522-1248
Practice Address - Street 1:2516 WAYNE WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7883
Practice Address - Country:US
Practice Address - Phone:972-522-1248
Practice Address - Fax:972-522-1248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PRIMARY HOME HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health