Organization
EAGLE ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY WELDON (ADMINISTRATOR)
(509) 946-8095
Entity
Organization
Contact information
Practice address
1745 PIKE AVE, RICHLAND, WA 99354-2295
(509) 946-8095
Mailing address
1745 PIKE AVE, RICHLAND, WA 99354-2295
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
BH1741
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
383641
—
WA
Enumeration date
10/27/2006
Last updated
08/22/2020
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