Provider Demographics
NPI:1306931944
Name:EAGLE HEALTHCARE AT CAMAS
Entity type:Organization
Organization Name:EAGLE HEALTHCARE AT CAMAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CURRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-285-3886
Mailing Address - Street 1:740 NE DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:425-285-3891
Mailing Address - Fax:425-285-3899
Practice Address - Street 1:640 NE EVERETT
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:360-834-5055
Practice Address - Fax:360-834-0504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1159314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111597Medicaid
WA4111597Medicaid