Eternity Services LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ETERNITY SERVICES LLC

Practice address

2200 W Bethany Home Rd Ste 1
Phoenix, AZ 85015-1937

Phone

(602) 601-4104

NPI assigned

Jun 8, 2022

Last updated

Jun 8, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Derrick Montgomery

Title

Managing Partner

Phone

(602) 621-5126

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1013646678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 W MYRTLE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850517538",
            "telephone_number": "602-621-5126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W BETHANY HOME RD STE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151937",
            "telephone_number": "602-601-4104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNITY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "602-621-5126"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eternity Hospice and Palliative Care, PLLC
• Cristina Rose Etienne, P.A.
• Gregory C Etienne, PA
• Samantha Valerie Etienne, MD
• Samuel Lucas Etling
• Ali Etman

• Mental Health Clinic/Center (Including Community Mental Health Center) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.