Provider Demographics
NPI:1841848132
Name:EAGLES WINGS COORDINATED CARE
Entity type:Organization
Organization Name:EAGLES WINGS COORDINATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FLEETWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:FOUNDER
Authorized Official - Phone:360-801-7039
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:PO BOX 2168
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-2168
Mailing Address - Country:US
Mailing Address - Phone:360-801-7039
Mailing Address - Fax:360-627-8340
Practice Address - Street 1:3029 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3435
Practice Address - Country:US
Practice Address - Phone:360-801-7039
Practice Address - Fax:360-627-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health