Healthcare Provider Details

I. General information

NPI: 1821400987
Provider Name (Legal Business Name): ETERNITYS PEAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 S VALLEY VIEW BLVD
LAS VEGAS NV
89102-7890
US

IV. Provider business mailing address

3081 S VALLEY VIEW BLVD
LAS VEGAS NV
89102-7890
US

V. Phone/Fax

Practice location:
  • Phone: 702-910-3230
  • Fax: 702-910-3231
Mailing address:
  • Phone: 702-910-3230
  • Fax: 702-910-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SARITA EDWARDS
Title or Position: OWNER
Credential:
Phone: 702-910-3230