MEDICARE: ETERNAL LOVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225653181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETERNAL LOVE LLC

Provider Business Mailing Address
First Line	:	5414 N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	262-933-4020
Fax Number	:	262-933-4025

Provider Business Practice Location Address
First Line	:	5414 N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	262-933-4020
Fax Number	:	262-933-4025

Authorized Official
Title or Position	:	OWNER
Name	:	TEANNA ROBINSON
Credential	:
Telephone Number	:	262-933-4020

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	01/15/2024

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Directions to “ETERNAL LOVE LLC ” Practice Location

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