Provider Demographics
NPI:1053007666
Name:EAGLES NEST PALLIATIVE HOSPICE LLC
Entity type:Organization
Organization Name:EAGLES NEST PALLIATIVE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-875-8773
Mailing Address - Street 1:6776 SOUTHWEST FWY STE 631
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6776 SOUTHWEST FWY STE 631
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2107
Practice Address - Country:US
Practice Address - Phone:713-875-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based