Provider Demographics
NPI:1619538493
Name:ETERNITY HOME HEALTH INC
Entity Type:Organization
Organization Name:ETERNITY HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARUNCHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-931-9352
Mailing Address - Street 1:12650 WORLD PLAZA LN # 72-2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4077
Mailing Address - Country:US
Mailing Address - Phone:239-931-9352
Mailing Address - Fax:
Practice Address - Street 1:12650 WORLD PLAZA LN # 72-2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4077
Practice Address - Country:US
Practice Address - Phone:239-931-9352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health