=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033099924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ETERNAL HOMECARE SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2025
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 CYPRESS ST STE C
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95437-5439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-964-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 CYPRESS ST STE C
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95437-5439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-964-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/ ADMINISTRATOR
-----------------------------------------------------
Name | EMILY MADRID
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 707-972-8330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------