Provider Demographics
NPI:1093699936
Name:EAGLE LAKE RECOVERY LLC
Entity type:Organization
Organization Name:EAGLE LAKE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR & COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-237-0252
Mailing Address - Street 1:300 WASHINGTON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6762
Mailing Address - Country:US
Mailing Address - Phone:318-237-0252
Mailing Address - Fax:
Practice Address - Street 1:135 HIGHWAY 556
Practice Address - Street 2:
Practice Address - City:CHOUDRANT
Practice Address - State:LA
Practice Address - Zip Code:71227-2300
Practice Address - Country:US
Practice Address - Phone:318-237-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility