Provider Demographics
NPI:1679344972
Name:EAGLES WILL NC LLC
Entity type:Organization
Organization Name:EAGLES WILL NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-648-4292
Mailing Address - Street 1:1413 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3613
Mailing Address - Country:US
Mailing Address - Phone:917-648-4292
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 420
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:917-648-4292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health