Provider Demographics
NPI:1386004398
Name:THE ETERNITY CHALLENGE
Entity Type:Organization
Organization Name:THE ETERNITY CHALLENGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-716-5029
Mailing Address - Street 1:4200 ROCKLIN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2860
Mailing Address - Country:US
Mailing Address - Phone:916-624-4428
Mailing Address - Fax:
Practice Address - Street 1:4200 ROCKLIN RD STE 1
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2860
Practice Address - Country:US
Practice Address - Phone:916-624-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility