Provider Demographics
NPI:1942011978
Name:EAGLES WINGS HOMES LLC
Entity type:Organization
Organization Name:EAGLES WINGS HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAYOKUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-460-8801
Mailing Address - Street 1:1366 WOODLAND PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-6903
Mailing Address - Country:US
Mailing Address - Phone:417-460-8801
Mailing Address - Fax:
Practice Address - Street 1:1366 WOODLAND PASS
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-6903
Practice Address - Country:US
Practice Address - Phone:417-460-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health