EAGLE ACQUISITION I LLC (NPI# 1265956965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265956965 |
| Entity Type | Organization |
| Organization Name | EAGLE ACQUISITION I LLC |
| Other Organization Name | CONCORDIA NURSING AND REHABILITATION CENTER - LAFAYETTE |
| Practice Address |
110 Brandywine Blvd Fayetteville GA 30214-1500 |
| Practice Telephone | (770) 461-2928 |
| Practice Fax Number | 7704618507 |
| Mailing Telephone | 7704612928 |
| Mailing Fax Number | 7704618507 |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2017-08-03 |
| Authorized Official Name | BENT PHILIPSON (MANAGING MEMBER) |
| Authorized Official Telephone | 5168693700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00399737A | 05 |
| Other Name | Type Code |
|---|---|
| Concordia Nursing and Rehabilitation Center - Lafayette | Doing Business As Name - Organization |
| Street Address |
110 BRANDYWINE BLVD |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740368612 | Lafayette Health Care Center, Inc. | Skilled Nursing Facility | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2006-11-01 |
| 1740836832 | Fayetteville Ga Opco LLC | Respite Care | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2019-08-14 |
| 1114490943 | Napoleon T Williams | Physical Therapy Assistant | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2019-01-03 |
| 1073892394 | Tasha Lynne Smith | Physical Therapy Assistant | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2011-08-04 |
| 1083992069 | Marie Pierre Gretchaida Louis | Occupational Therapy Assistant | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2011-07-25 |
| 1881972966 | Eloise T Norris | Speech-Language Pathologist | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2011-07-24 |
| 1053609172 | Myra Francisco | Physical Therapist | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2011-07-11 |
| 1144478975 | Preeti Virendra Ranadive | Physical Therapist | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2008-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831625037 | Supplemental Healthcare | Skilled Nursing Facility | 319 Vancouver Drive, Apartment 38g, Fayetteville, NC 28303 | 2017-05-08 |
| 1659764447 | Kathleen Mason | Skilled Nursing Facility | 13 Lorelei Dr, Fayetteville, OH 45118-8404 | 2015-03-18 |
| 1083917413 | Autumn Corporation | Skilled Nursing Facility | 1401 71st School Rd, Fayetteville, NC 28314-2814 | 2010-12-07 |
| 1194044941 | Wcnc, Inc. | Skilled Nursing Facility | 4405 Persimmon Street, Fayetteville, AR 72704 | 2010-05-19 |
| 1962674796 | Tison Speech Therapy Services | Skilled Nursing Facility | 1387 N Bernice Dr, Fayetteville, AR 72703-6086 | 2008-04-01 |
| 1851443022 | Washington Regional Medicorp, Inc. | Skilled Nursing Facility | 221 S School Ave, Fayetteville, AR 72701-5969 | 2007-01-17 |
| 1871659730 | Fayette Nursing & Rehabilitation Center LLC | Skilled Nursing Facility | 100 Hresan Blvd, Fayetteville, WV 25840-1333 | 2006-12-28 |
| 1740368612 | Lafayette Health Care Center, Inc. | Skilled Nursing Facility | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2006-11-01 |
| 1417052895 | State of Arkansas | Skilled Nursing Facility | 1179 N. College Avenue, Fayetteville, AR 72703 | 2006-09-13 |
| 1699886085 | Highland House of Fayetteville, Inc | Skilled Nursing Facility | 1700 Pamalee Dr, Fayetteville, NC 28301-2824 | 2006-08-31 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on EAGLE ACQUISITION I LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.