Provider Demographics
NPI:1487324851
Name:FRIENDS FOR ETERNITY HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:FRIENDS FOR ETERNITY HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANEAR
Authorized Official - Middle Name:MONISHA
Authorized Official - Last Name:MCCLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-715-5286
Mailing Address - Street 1:6824 MARSDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2220
Mailing Address - Country:US
Mailing Address - Phone:215-715-5286
Mailing Address - Fax:
Practice Address - Street 1:6824 MARSDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-2220
Practice Address - Country:US
Practice Address - Phone:215-715-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty