Provider Demographics
NPI:1841513520
Name:ETERNAL HANDHOME CARE
Entity type:Organization
Organization Name:ETERNAL HANDHOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH CARE SERVICES
Authorized Official - Phone:337-579-2025
Mailing Address - Street 1:1400E.MAIN STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544
Mailing Address - Country:US
Mailing Address - Phone:337-579-2025
Mailing Address - Fax:337-579-2143
Practice Address - Street 1:1400 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544
Practice Address - Country:US
Practice Address - Phone:337-579-2025
Practice Address - Fax:337-579-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1002195443253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care