Organization
ETERNAL LIFE SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTAVO RODRIGUEZ (CEO)
(305) 753-6270
Entity
Organization
Contact information
Practice address
15552 SW 11TH TER, MIAMI, FL 33194-2789
(305) 753-6270
Mailing address
15552 SW 11TH TER, MIAMI, FL 33194-2789
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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