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General NPI Number Information
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NPI Number | 1194590729
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Entity Type | Organization
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Legal Business Name | ETERNAL HOPE THERAPEUTICS LLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 616 ALBEMARLE RD
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City | ASHEBORO
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State | NC
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Zip | 27203-6259
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Country | US
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Telephone | 336-628-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 1383 WALKER RD
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City | ASHEBORO
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State | NC
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Zip | 27205-2225
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Country | US
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Telephone | 336-953-7004
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Fax | 743-224-4381
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. HEATHER VUNCANNON
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Credential |
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Telephone | 336-953-7004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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