1982760971 NPI number — GRAEAGLE CONSTRUCTION LLC

Table of content: (NPI 1982760971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982760971 NPI number — GRAEAGLE CONSTRUCTION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAEAGLE CONSTRUCTION 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:
Provider Other Organization Name Type Code:
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:
1982760971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5016 CECILE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89115-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-248-0170
Provider Business Mailing Address Fax Number:
702-248-7093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5016 CECILE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89115-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-248-0170
Provider Business Practice Location Address Fax Number:
702-248-7093
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCRIBNER
Authorized Official First Name:
RAINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
702-248-0170

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X , with the licence number:  52659 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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