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Organization
ETHEREAL HOME MEDICAL LLC
Active
Organization
ETHEREAL HOME MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATINA WILLIAMS (ASSISTANT DIRECTOR)
(336) 303-2778
Entity
Organization
Contact information
Practice address
2216 W MEADOWVIEW RD STE 264, GREENSBORO, NC 27407-3406
(336) 303-2778
Mailing address
3902 WOODBERRY LAKE DR, GREENSBORO, NC 27455-0944
(336) 303-2778
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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