Provider Demographics
NPI:1992229603
Name:EAGLE ACQUISITION III LLC
Entity type:Organization
Organization Name:EAGLE ACQUISITION III 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 1:401 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1766
Mailing Address - Country:US
Mailing Address - Phone:270-247-0200
Mailing Address - Fax:270-247-8913
Practice Address - Street 1:401 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1766
Practice Address - Country:US
Practice Address - Phone:270-247-0200
Practice Address - Fax:270-247-8913
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