# AMERICAN EAGLE LEESBURG MC LLC

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

## Provider details

- **NPI number:** 1689152910
- **Authorized official:** CORY WAKE (ASSOCIATE)
- **Authorized official phone:** (734) 418-9027

## Contact information

- **Practice address:** 710 S LAKE ST, LEESBURG, FL 34748-7327
- **Practice address phone:** (734) 418-9027
- **Mailing address:** 3819 HAWK CREST RD, ANN ARBOR, MI 48103-4246
- **Mailing address phone:** (734) 418-9027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | — | NULL | Yes |

## Other

- **Enumeration date:** 07/30/2018
- **Last updated:** 07/30/2018