Provider Demographics
NPI:1770998296
Name:CLARE EAGLE NURSING SERVICES LLC
Entity type:Organization
Organization Name:CLARE EAGLE NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:LYDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASU TAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-284-9318
Mailing Address - Street 1:450 N EUCALYPTUS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8257
Mailing Address - Country:US
Mailing Address - Phone:480-284-9318
Mailing Address - Fax:480-304-3129
Practice Address - Street 1:11158 W FILMORE ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-7911
Practice Address - Country:US
Practice Address - Phone:480-284-9318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances