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General NPI Number Information
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NPI Number | 1306783147
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Entity Type | Organization
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Legal Business Name | ETERNITY CARE HOME 2
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 518 W GRANGER AVE
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City | MODESTO
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State | CA
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Zip | 95350-4255
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Country | US
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Telephone | 209-450-7283
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Fax | 209-567-2761
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Provider Business Mailing Address
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Address Line | 518 W GRANGER AVE
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City | MODESTO
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State | CA
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Zip | 95350-4255
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Country | US
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Telephone | 209-450-7283
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Fax | 209-567-2761
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Authorized Official
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Title or Position | LICENSEE
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Name | MARIA PETALLO PAYLA
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Credential | ADMINISTRATOR
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Telephone | 209-450-7283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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