Provider Demographics
NPI:1164285789
Name:ETERNAL SENIOR LIVING LLC
Entity Type:Organization
Organization Name:ETERNAL SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UNIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-542-4079
Mailing Address - Street 1:3269 E SAMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3269 E SAMPLE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5910
Practice Address - Country:US
Practice Address - Phone:323-542-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient