Provider Demographics
NPI:1053722280
Name:EAGLE ADVANCEMENT INSTITUTE
Entity type:Organization
Organization Name:EAGLE ADVANCEMENT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-562-7284
Mailing Address - Street 1:7091 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3654
Mailing Address - Country:US
Mailing Address - Phone:248-562-7284
Mailing Address - Fax:248-707-1081
Practice Address - Street 1:7091 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3654
Practice Address - Country:US
Practice Address - Phone:248-562-7284
Practice Address - Fax:248-707-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2527661261QM1300X
MISA0631360276400000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility