Eagle Healthy Living Inc

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

309007616 Issued in IL

Legal business name

EAGLE HEALTHY LIVING INC

Practice address

16057 School St
South Holland, IL 60473-1630

Phone

(708) 692-2903

NPI assigned

Aug 5, 2016

Organization subpart

No

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

Authorized official

Name

William Rodney Bryant

Title

Chief Executive Officer

Phone

(708) 692-2903

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470355200000",
    "number": "1700330826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16057 SCHOOL ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731630",
            "telephone_number": "708-692-2903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16057 SCHOOL ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731630",
            "telephone_number": "708-692-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE HEALTHY LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2016-08-05",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "RODNEY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "708-692-2903"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "IL",
            "license": "309007616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in South Holland, IL
• Providers in South Holland, IL by specialty
• Health Maintenance Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; 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.