Provider Demographics
NPI:1912471087
Name:AMERICAN EAGLE PALMER PARK LLC
Entity Type:Organization
Organization Name:AMERICAN EAGLE PALMER PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-418-9027
Mailing Address - Street 1:3819 HAWK CREST RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4246
Mailing Address - Country:US
Mailing Address - Phone:734-418-9027
Mailing Address - Fax:
Practice Address - Street 1:2850 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5306
Practice Address - Country:US
Practice Address - Phone:734-418-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility