Provider Demographics
NPI:1588751697
Name:EAGLE HEALTHCARE, INC
Entity type:Organization
Organization Name:EAGLE HEALTHCARE, INC
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 1:12015 115TH AVE NE #E195
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-285-3891
Mailing Address - Fax:425-285-3899
Practice Address - Street 1:1242 11TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2815
Practice Address - Country:US
Practice Address - Phone:509-758-2523
Practice Address - Fax:509-751-9427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1137314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111373Medicaid
WA505283Medicare Oscar/Certification