Provider Demographics
NPI:1508625336
Name:ETERNAL HOSPICE
Entity Type:Organization
Organization Name:ETERNAL HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, DPCS, RN
Authorized Official - Prefix:
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-637-0002
Mailing Address - Street 1:6655 W SAHARA AVE STE S-108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0842
Mailing Address - Country:US
Mailing Address - Phone:708-522-8498
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE S-108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:708-522-8498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based