Provider Demographics
NPI:1477855930
Name:ETERNAL HOPE AND LIFE, LLC
Entity Type:Organization
Organization Name:ETERNAL HOPE AND LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-591-5131
Mailing Address - Street 1:2045 MOUNT ZION RD # 337
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3313
Mailing Address - Country:US
Mailing Address - Phone:404-591-5131
Mailing Address - Fax:404-420-2483
Practice Address - Street 1:7349 POPPY WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-3411
Practice Address - Country:US
Practice Address - Phone:404-591-5131
Practice Address - Fax:404-420-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0600137983104A0625X, 3104A0630X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances