Provider Demographics
NPI:1114211901
Name:ETERNITY ESTATES CORP.
Entity Type:Organization
Organization Name:ETERNITY ESTATES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-444-4662
Mailing Address - Street 1:2987 SW 16TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1957
Mailing Address - Country:US
Mailing Address - Phone:786-444-4662
Mailing Address - Fax:
Practice Address - Street 1:2987 SW 16TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1957
Practice Address - Country:US
Practice Address - Phone:786-444-4662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11977310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility