MEDICARE: ETERNAL CCA, INC.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1619656766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETERNAL CCA, INC.

Provider Business Mailing Address
First Line	:	4165 E THOUSAND OAKS BLVD
Second Line	:	SUITE 325C
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3814
Country	:	US
Telephone Number	:	805-344-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4165 E THOUSAND OAKS BLVD
Second Line	:	SUITE 325C
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3814
Country	:	US
Telephone Number	:	805-344-5544
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEKSANDRA DUBINA
Credential	:
Telephone Number	:	805-344-5544

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	12/22/2025

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