Healthcare Provider Details

I. General information

NPI: 1740117035
Provider Name (Legal Business Name): ETERNA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13885 HEDGEWOOD DR STE 341
WOODBRIDGE VA
22193-7933
US

IV. Provider business mailing address

13885 HEDGEWOOD DR STE 341
WOODBRIDGE VA
22193-7933
US

V. Phone/Fax

Practice location:
  • Phone: 571-235-0564
  • Fax:
Mailing address:
  • Phone:
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: FAHIM RUSTAEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 571-235-0564