EAGLE HOME CARE LLC , NPI 1265996466 — LOS ANGELES (CA)

NPI 1265996466

1+ Years Experience Organization

EAGLE HOME CARE LLC

01/22/2019
PROVIDER ENUMERATION DATE
01/22/2019
LAST UPDATE DATE
1265996466
NPI NUMBER

About EAGLE HOME CARE LLC

EAGLE HOME CARE LLC is a provider established in LOS ANGELES, CA. The NPI number of EAGLE HOME CARE LLC is 1265996466 and was assigned on 01/22/2019. The practitioners primary taxonomy code is: 311ZA0620X .

Mailing address

  • City: LOS ANGELES
  • State: CA
  • Postal code: 900458630
  • Phone: 3103169200
  • Fax: 3103291213
  • Address: 8655 BELFORD AVE APT 123

Primary Practice Address

  • Region : LOS ANGELES, CA
  • NPI : 1265996466
  • Phone : 3103169200
  • Fax : 3103291213
  • Postalcode : 900458630
  • Address : 8655 BELFORD AVE APT 123

Additional identifiers

  • Identifier: Y2888783
  • Code / Type : 1 - other
  • Identifier state : CA
  • Identifier issuer: PERSONAL CARE AGENCY

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Custodial Care Facility

  • Taxonomy code: 311ZA0620X

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

Contacts:

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  • EAGLE HOME CARE LLC
  • Address : 8655 BELFORD AVE APT 123
  • Region : LOS ANGELES, CA
  • NPI : 1265996466
  • Phone : 3103169200
  • Fax : 3103291213
  • Postalcode : 900458630

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 3103169200
  • Title or position : CEO

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address8655 BELFORD AVE APT 123
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLOS ANGELES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code900458630
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3103169200
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3103291213
The fax number associated with the location address of the provider being identified.
NPI1265996466
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1311ZA0620X
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
Provider Enumeration Date01/22/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated01/22/2019
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Organization SubpartN
The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes. Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents"). Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents": (1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should. (2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should. (3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don"t know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
Provider Organization Name (Legal Business Name)EAGLE HOME CARE LLC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address8655 BELFORD AVE APT 123
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameLOS ANGELES
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code900458630
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3103169200
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3103291213
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameGILLIARD
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameNATALIE
The first name of the authorized official
Authorized Official Title or PositionCEO
The title or position of the authorized official
Authorized Official Telephone Number3103169200
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1311ZA0620X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Custodial Care Facility
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1Y2888783
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1CA
Other Provider Identifier State #1
Other Provider Identifier Issuer 1PERSONAL CARE AGENCY
Other Provider Identifier Issuer #1
X

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