Eagle Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

BH1741 Issued in WA

Legal business name

EAGLE ASSISTED LIVING

Practice address

1745 Pike Ave
Richland, WA 99354-2295

Phone

(509) 946-8095

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Jerry Weldon

Title

Administrator

Phone

(509) 946-8095

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Eagle Healthcare at Camas2 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.

• Parkway North Care Center

  • Skilled Nursing Facility
  • Kirkland, WA
  • NPI 1710028303
  NPD tax ID

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619053352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 PIKE AVE",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993542295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 PIKE AVE",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993542295",
            "telephone_number": "509-946-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WELDON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-946-8095"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "BH1741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "383641",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Renee Dusky, PHARMD
• Jason Ryan Dutton, D.O.
• Jean-Michel Duval
• Duvera Therapy PLLC
• Vladimir Dzhashi, MD
• Eagle Healthcare, Inc (Richland Rehabilitation Center)
• Jeffrey Douglas Eaton, RN
• Jose Fernando Echaiz Arroyo, MD
• Theresa A Echaiz, PHARMD
• Echo Echo, LMP

• Assisted Living Facility in Richland, WA
• Providers in Richland, WA by specialty
• Assisted Living Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.