Provider Demographics
NPI:1548927957
Name:EAGLE EYE HOME CARE LLC
Entity type:Organization
Organization Name:EAGLE EYE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-332-1119
Mailing Address - Street 1:2824 COTTMAN AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1400
Mailing Address - Country:US
Mailing Address - Phone:718-332-1119
Mailing Address - Fax:
Practice Address - Street 1:2824 COTTMAN AVE STE 7
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1400
Practice Address - Country:US
Practice Address - Phone:718-332-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care