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General NPI Number Information
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NPI Number | 1619538493
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Entity Type | Organization
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Legal Business Name | ETERNITY HOME HEALTH INC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 12650 WORLD PLAZA LN # 72-2
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City | FORT MYERS
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State | FL
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Zip | 33907-4077
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Country | US
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Telephone | 239-931-9352
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Fax |
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Provider Business Mailing Address
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Address Line | 12650 WORLD PLAZA LN # 72-2
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City | FORT MYERS
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State | FL
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Zip | 33907-4077
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Country | US
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Telephone | 239-931-9352
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAVIER A CARUNCHO
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Credential |
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Telephone | 239-931-9352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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