Provider Demographics
NPI:1720772833
Name:ETERNITY LIFE CARE LLC
Entity Type:Organization
Organization Name:ETERNITY LIFE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FINALES SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-652-9880
Mailing Address - Street 1:13301 SW 132ND AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6189
Mailing Address - Country:US
Mailing Address - Phone:786-652-9880
Mailing Address - Fax:786-652-9879
Practice Address - Street 1:13301 SW 132ND AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6189
Practice Address - Country:US
Practice Address - Phone:786-652-9880
Practice Address - Fax:786-652-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251J00000XAgenciesNursing Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty