Organization
EAGLE RESPONSE CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROLANDO ENRIQUEZ (CHIEF EXECUTIVE OFFICER)
(626) 430-8825
Entity
Organization
Contact information
Practice address
550 S GLENDORA AVE, WEST COVINA, CA 91790-3079
(626) 430-8825
Mailing address
550 S GLENDORA AVE, WEST COVINA, CA 91790-3079
(626) 430-8825
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
C3142033
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3142033
STATE OF CALIFORNIA - CORPORATE IDENTIFICATION NUMBER
CA
Enumeration date
04/29/2009
Last updated
11/08/2012
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