Eagle Therapy LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

EAGLE THERAPY LLC

Practice address

2745 Herschel St N
A109
Roseville, MN 55113

Phone

(614) 596-3566

NPI assigned

Jul 23, 2024

Last updated

Jul 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Omar Eleye

Title

Ceo

Phone

(614) 596-3566

Specialties & licenses 2

Addresses

Tax ID family

Eagle Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eagle Therapy LLC

  • Developmental Disabilities Clinic/Center
  • Bloomington, MN
  • NPI 1598593972
  NPD tax ID

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1114755923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 AMERICAN BLVD W STE 1500",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554314429",
            "telephone_number": "614-596-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2745 HERSCHEL ST N",
            "address_2": "A109",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "614-596-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-13",
        "status": "A",
        "authorized_official_last_name": "ELEYE",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "614-596-3566"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Duevel, LICSW, LADC
• Jacqueline Kay Ford Dufour, CRNA
• Mikaela R Dunn, LICSW
• Ayanna Elizabeth Duren, M.A., LAMFT
• Dynamic Health Care (Dynamic health)
• Eaglecrest Senior Housing, LLC
• Early Success Therapy Services
• Eastern Health Inc
• Alivia Ebacher, LMFT
• Erica Marie Eckroth, RN

• Developmental Disabilities Clinic/Center in Roseville, MN
• Providers in Roseville, MN by specialty
• Developmental Disabilities Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.