Eagle Acquisition XV LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EAGLE ACQUISITION XV LLC

Practice address

200 W Constance Rd
Suffolk, VA 23434-4413

Phone

(757) 539-8744

Fax

(757) 539-6128

NPI assigned

Aug 3, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bent Philipson

Title

Managing Member

Phone

(516) 869-3700

Specialties & licenses 1

Addresses

Other names 1

• Concordia Assisted Living - Nansemond Commons Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053836726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W CONSTANCE RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344413",
            "telephone_number": "757-539-8744",
            "fax_number": "757-539-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W CONSTANCE RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344413",
            "telephone_number": "757-539-8744",
            "fax_number": "757-539-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ACQUISITION XV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PHILIPSON",
        "authorized_official_first_name": "BENT",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "516-869-3700"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concordia Assisted Living - Nansemond Commons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas J Duntemann, MD
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• Jawahar Khan Durrani, M.D.
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• Assisted Living Facility in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Assisted Living Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.