1326193863 NPI number — EAGLE HEALTHCARE INC

Table of content: (NPI 1326193863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326193863 NPI number — EAGLE HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE ORCHARDS CARE & REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326193863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12015 115TH AVE NE # E195
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-6940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-285-3891
Provider Business Mailing Address Fax Number:
425-285-3899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1014 BURRELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83501-5472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-743-4558
Provider Business Practice Location Address Fax Number:
208-746-7657
Provider Enumeration Date:
01/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
425-285-3891

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  30 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805587500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".