# EAGLE THERAPY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114755923
- **Authorized official:** OMAR ELEYE (CEO)
- **Authorized official phone:** (614) 596-3566

## Contact information

- **Practice address:** 2745 HERSCHEL ST N, A109, ROSEVILLE, MN 55113
- **Practice address phone:** (614) 596-3566
- **Mailing address:** 3800 AMERICAN BLVD W STE 1500, BLOOMINGTON, MN 55431-4429
- **Mailing address phone:** (614) 596-3566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | — |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/23/2024
- **Last updated:** 07/23/2024