Provider Demographics
NPI:1497150601
Name:ETERNITY ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:ETERNITY ADULT DAY CARE LLC
Other - Org Name:NA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-383-5437
Mailing Address - Street 1:2402-04 SARAH
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-2921
Mailing Address - Country:US
Mailing Address - Phone:314-531-9025
Mailing Address - Fax:
Practice Address - Street 1:2402 N SARAH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-2921
Practice Address - Country:US
Practice Address - Phone:314-531-9025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care