| Eagle House Llc | |
|
4027 S 96th Drive Phoenix AZ 85008-8500 | |
| (715) 202-3461 | |
| Not Available |
| Full Name | Eagle House Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4027 S 96th Drive, Phoenix, Arizona |
| Authorized Official Name and Position | Mataele Kaveinga (CEO) |
| Authorized Official Contact | 7152023461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle House Llc 1364 N Constellation Way Gilbert AZ 85234-1458 Ph: (715) 202-3461 | Eagle House Llc 4027 S 96th Drive Phoenix AZ 85008-8500 Ph: (715) 202-3461 |
| NPI Number | 1528661584 |
|---|---|
| Provider Enumeration Date | 11/20/2020 |
| Last Update Date | 11/20/2020 |
| Certification Date | 11/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528661584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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