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General NPI Number Information
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NPI Number | 1730919192
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Entity Type | Organization
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Legal Business Name | ETERNAL GUARDIAN HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1505 W OAK ST STE 140
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City | ZIONSVILLE
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State | IN
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Zip | 46077-2058
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Country | US
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Telephone | 317-407-3616
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Fax | 877-804-2638
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Provider Business Mailing Address
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Address Line | 3706 W FERGUSON RD
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City | FORT WAYNE
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State | IN
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Zip | 46809-3157
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Country | US
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Telephone | 317-407-3616
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAFUBA DONZON
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Credential |
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Telephone | 678-860-9669
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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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