Provider Demographics
NPI:1699377549
Name:ETERNITY HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ETERNITY HOME HEALTH CARE LLC
Other - Org Name:ETERNITY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:AMABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONGOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-374-6878
Mailing Address - Street 1:4140 N 108TH AVE STE 101C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5466
Mailing Address - Country:US
Mailing Address - Phone:602-675-2556
Mailing Address - Fax:888-778-1251
Practice Address - Street 1:4140 N 108TH AVE STE 101C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5466
Practice Address - Country:US
Practice Address - Phone:623-203-3139
Practice Address - Fax:888-778-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-14
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health