Healthcare Provider Details

I. General information

NPI: 1144938309
Provider Name (Legal Business Name): ETERNITY BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 HILLTOP LOOP
APOPKA FL
32712-4802
US

IV. Provider business mailing address

2725 HILLTOP LOOP
APOPKA FL
32712-4802
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-8967
  • Fax:
Mailing address:
  • Phone: 407-567-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NEESHAWN FERDINAND
Title or Position: OWNER
Credential:
Phone: 407-567-8967