Organization
ETERNAL HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON BLASSE (EXECUTIVE DIRECTOR)
(704) 796-1156
Entity
Organization
Contact information
Practice address
4111 ZEBULON AVE SW, CONCORD, NC 28027-9209
(704) 796-1156
Mailing address
4111 ZEBULON AVE SW, CONCORD, NC 28027-9209
(704) 796-1156
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/16/2024
Last updated
10/28/2025
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