Provider Demographics
NPI:1003229667
Name:ETI HEALTHCARE LLC
Entity Type:Organization
Organization Name:ETI HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:QUEENY
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-790-9333
Mailing Address - Street 1:2170 BANKSTON CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5718
Mailing Address - Country:US
Mailing Address - Phone:678-790-9333
Mailing Address - Fax:
Practice Address - Street 1:2170 BANKSTON CIR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5718
Practice Address - Country:US
Practice Address - Phone:678-790-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health