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General NPI Number Information
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NPI Number | 1760781413
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Entity Type | Organization
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Legal Business Name | ETERNITY HEALTH CARE SERVICES
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 10316 PLACER LN STE A
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City | SACRAMENTO
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State | CA
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Zip | 95827-2557
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Country | US
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Telephone | 916-363-2094
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Fax | 916-363-2621
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Provider Business Mailing Address
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Address Line | 10316 PLACER LN STE A
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City | SACRAMENTO
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State | CA
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Zip | 95827-2557
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Country | US
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Telephone | 916-363-2094
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Fax | 916-363-2621
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Authorized Official
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Title or Position | PARTNER/GENERAL MANAGER
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Name | MR. NORRIS HOWARD MOORE SR.
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Credential |
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Telephone | 916-363-2094
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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 | 309281
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License Number State | CA
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