Healthcare Provider Details

I. General information

NPI: 1598593378
Provider Name (Legal Business Name): ETERNAL HOMECARE & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MAXWELL AVE STE 201
GREENWOOD SC
29646-2641
US

IV. Provider business mailing address

405 FAIRFOREST DR
GREENWOOD SC
29646-7841
US

V. Phone/Fax

Practice location:
  • Phone: 864-993-7009
  • Fax:
Mailing address:
  • Phone: 864-993-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CANDACE CUNNINGHAM- THOMPSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 864-993-7009