Provider Demographics
NPI:1699591545
Name:EAGLES AT HOME LLC
Entity type:Organization
Organization Name:EAGLES AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVA LYNN
Authorized Official - Middle Name:MURRAY
Authorized Official - Last Name:CHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-894-3505
Mailing Address - Street 1:3455 PATEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-8747
Mailing Address - Country:US
Mailing Address - Phone:229-894-3505
Mailing Address - Fax:
Practice Address - Street 1:3455 PATEVILLE RD
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-8747
Practice Address - Country:US
Practice Address - Phone:229-894-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care