Healthcare Provider Details

I. General information

NPI: 1699612838
Provider Name (Legal Business Name): ETERNAL SUPPORTIVE HOUSING OP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

IV. Provider business mailing address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

V. Phone/Fax

Practice location:
  • Phone: 860-710-4507
  • Fax:
Mailing address:
  • Phone: 860-710-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHMUEL KAHN
Title or Position: OWNER
Credential:
Phone: 860-710-4507