Provider Demographics
NPI:1629384060
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:CO-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-591-5131
Mailing Address - Street 1:2045 MT. ZION RD
Mailing Address - Street 2:#337
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260
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:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health