Provider Demographics
NPI:1194240853
Name:EAGLE ACQUISITION XI LLC
Entity type:Organization
Organization Name:EAGLE ACQUISITION XI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-869-3700
Mailing Address - Street 1:1520 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1575
Mailing Address - Country:US
Mailing Address - Phone:865-458-5436
Mailing Address - Fax:865-458-3033
Practice Address - Street 1:1520 GROVE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1575
Practice Address - Country:US
Practice Address - Phone:865-458-5436
Practice Address - Fax:865-458-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility