Healthcare Provider Details

I. General information

NPI: 1184755613
Provider Name (Legal Business Name): ETERNAL BLESSINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 HIGHWAY 34
CHATHAM LA
71226-9326
US

IV. Provider business mailing address

PO BOX 386
CHATHAM LA
71226-0386
US

V. Phone/Fax

Practice location:
  • Phone: 318-249-4562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number9809
License Number StateLA

VIII. Authorized Official

Name: MARION PEEL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 318-249-4562