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General NPI Number Information
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NPI Number | 1417114000
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Entity Type | Organization
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Legal Business Name | ETERNITY HOME CARE, INC.
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 3750 WEST 16TH AVENUE SUITE 128U
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-698-1914
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Fax | 305-698-1917
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Provider Business Mailing Address
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Address Line | 3750 WEST 16TH AVENUE SUITE 128U
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-698-1914
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Fax | 305-698-1917
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JESUS A. ACOSTA
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Credential |
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Telephone | 305-698-1914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 299993016
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299993016
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 26-03422087
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License Number State | FL
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