Organization
ETERNITY HOMECARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY KLINE BURNETT MBA (BUSINESS LIAISON)
(608) 251-2273
Entity
Organization
Contact information
Practice address
1402 GREENWAY CROSS, SUITE 101, MADISON, WI 53713-3181
(608) 251-2273
(866) 748-3232
Mailing address
1402 GREENWAY CROSS, SUITE 101, MADISON, WI 53713-3181
(608) 251-2273
(866) 748-3232
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
100014484
WI
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
100014484
WI
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
251T00000X
PACE Provider Organization
—
—
253Z00000X
In Home Supportive Care Agency
100014484
WI
253Z00000X
In Home Supportive Care Agency
—
—
302F00000X
Exclusive Provider Organization
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014484
—
WI
01
—
1770996100
INDIVIDUAL NPI
WI
Enumeration date
09/21/2015
Last updated
09/21/2015
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