Provider Demographics
NPI:1740853118
Name:EON RESOURCES CORP
Entity type:Organization
Organization Name:EON RESOURCES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-593-4567
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-0987
Mailing Address - Country:US
Mailing Address - Phone:909-593-4567
Mailing Address - Fax:909-971-3108
Practice Address - Street 1:2555 6TH ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-4617
Practice Address - Country:US
Practice Address - Phone:909-593-4567
Practice Address - Fax:909-971-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness