Provider Demographics
NPI:1619656766
Name:ETERNAL CCA, INC.
Entity Type:Organization
Organization Name:ETERNAL CCA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-344-5544
Mailing Address - Street 1:30941 AGOURA RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4687
Mailing Address - Country:US
Mailing Address - Phone:805-344-5544
Mailing Address - Fax:
Practice Address - Street 1:30941 AGOURA RD STE 112
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4687
Practice Address - Country:US
Practice Address - Phone:805-344-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty