Provider Demographics
NPI:1154368173
Name:AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC
Entity type:Organization
Organization Name:AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLMOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-252-2305
Mailing Address - Street 1:1600 DIVISION ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2754
Mailing Address - Country:US
Mailing Address - Phone:615-252-2305
Mailing Address - Fax:
Practice Address - Street 1:107 STACY DR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3740
Practice Address - Country:US
Practice Address - Phone:903-839-5050
Practice Address - Fax:903-839-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115430314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5753Medicare ID - Type Unspecified