Basic Information
| Provider Information | |||||||||
| NPI: | 1477615656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAGLEVILLE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 EAGLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194031829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105396000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 EAGLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194031829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105396000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCGLONE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2672912210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 461031 | PA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 128150 | 01 | PA | MBH OF PA | OTHER | 88299 | 01 | PA | CBH | OTHER | 1007779290005 | 05 | PA | MEDICAID | 0001185000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER |