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Organization
EAGLE THERAPY LLC
Active
Organization
EAGLE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR ELEYE (CEO)
(614) 596-3566
Entity
Organization
Contact information
Practice address
2745 HERSCHEL ST N, A109, ROSEVILLE, MN 55113
(614) 596-3566
Mailing address
3800 AMERICAN BLVD W STE 1500, BLOOMINGTON, MN 55431-4429
(614) 596-3566
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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