Organization
EAGLE HOUSE LLC
Active
Other names
Eagle House LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MATAELE KAVEINGA (CEO)
(715) 202-3461
Entity
Organization
Contact information
Practice address
4027 S 96TH DRIVE, PHOENIX, AZ 85008-8500
(715) 202-3461
Mailing address
1364 N CONSTELLATION WAY, GILBERT, AZ 85234-1458
(715) 202-3461
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/20/2020
Last updated
11/20/2020
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