Eagle Healthcare, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1137 Issued in WA

Legal business name

EAGLE HEALTHCARE, INC

Doing business as

Eagle Rehabilitation at Clarkston

Practice address

1242 11TH St
Clarkston, WA 99403-2815

Phone

(509) 758-2523

Fax

(509) 751-9427

NPI assigned

Oct 9, 2006

Last updated

Jun 20, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

EAGLE HEALTHCARE, INCAs reported in NPPES

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

Authorized official

Name

Curran Wong

Title

Corporate Services

Phone

(425) 285-3886

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eagle Rehabilitation at Clarkston Doing business as

Part of

Eagle Assisted Living

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1588751697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12015 115TH AVE NE #E195",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034",
            "telephone_number": "425-285-3891",
            "fax_number": "425-285-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1242 11TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032815",
            "telephone_number": "509-758-2523",
            "fax_number": "509-751-9427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE HEALTHCARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE HEALTHCARE, INC",
        "enumeration_date": "2006-10-09",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "CURRAN",
        "authorized_official_title_or_position": "CORPORATE SERVICES",
        "authorized_official_telephone_number": "425-285-3886"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4111373",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Rehabilitation at Clarkston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lonnie Druffel, RDH
• Terri J Drury, D.C.
• Brandon Dugdale
• Taylor Durant
• Charles C Dwyer, DC
• Corlene Ann Eberle, ARNP FNPC ANPC
• Educational and Psychological Services
• Mark T Eggleston, MD
• Richard J Eggleston, MD
• Omar Elhassadi, BDS, FFD, MSC

• Skilled Nursing Facility in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.