Healthcare Provider Details

I. General information

NPI: 1194590729
Provider Name (Legal Business Name): ETERNAL HOPE THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 ALBEMARLE RD
ASHEBORO NC
27203-6259
US

IV. Provider business mailing address

1383 WALKER RD
ASHEBORO NC
27205-2225
US

V. Phone/Fax

Practice location:
  • Phone: 336-628-0640
  • Fax:
Mailing address:
  • Phone: 336-953-7004
  • Fax: 743-224-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER VUNCANNON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-953-7004