Organization
EAGLES NEST GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA FOGAL (PROVIDER)
(775) 852-1078
Entity
Organization
Contact information
Practice address
4310 TORO CT, RENO, NV 89502-6426
(775) 852-1078
Mailing address
4310 TORO CT, RENO, NV 89502-6426
(775) 852-1078
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9005053465
—
NV
Enumeration date
03/30/2016
Last updated
03/30/2016
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