Provider Demographics
NPI:1225653181
Name:ETERNAL LOVE LLC
Entity Type:Organization
Organization Name:ETERNAL LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-933-4020
Mailing Address - Street 1:5414 N LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3006
Mailing Address - Country:US
Mailing Address - Phone:262-933-4020
Mailing Address - Fax:262-933-4025
Practice Address - Street 1:5414 N LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3006
Practice Address - Country:US
Practice Address - Phone:262-933-4020
Practice Address - Fax:262-933-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health