1154368173 NPI number — AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC

Table of content: (NPI 1154368173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154368173 NPI number — AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC
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:
OAK BROOK HEALTH CARE CENTER
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:
1154368173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 DIVISION ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-2754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-252-2305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 STACY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEHOUSE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75791-3740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-839-5050
Provider Business Practice Location Address Fax Number:
903-839-8461
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILLMOR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/DIRECTOR
Authorized Official Telephone Number:
615-252-2305

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  115430 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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