Provider Demographics
NPI:1538626452
Name:EAGLE HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:EAGLE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-381-7405
Mailing Address - Street 1:717 LEE ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1734
Mailing Address - Country:US
Mailing Address - Phone:424-381-7405
Mailing Address - Fax:
Practice Address - Street 1:717 LEE ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1734
Practice Address - Country:US
Practice Address - Phone:424-381-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7634423467Medicaid