Eternal Haven LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ETERNAL HAVEN LLC

Practice address

4111 Zebulon Ave SW
Concord, NC 28027-9209

Phone

(704) 796-1156

NPI assigned

Feb 16, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Brandon Blasse

Title

Executive Director

Phone

(704) 796-1156

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761609600000",
    "number": "1184489460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 ZEBULON AVE SW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280279209",
            "telephone_number": "704-796-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 ZEBULON AVE SW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280279209",
            "telephone_number": "704-796-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNAL HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-16",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A",
        "authorized_official_last_name": "BLASSE",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-796-1156",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seyedmohammadreza Esmaeilnejadganji, MD
• Angela Espin, LCSW
• John Esposito
• Essence Counseling and Wellness, PLLC
• Philip Estridge
• Lauren Russell Eubank, NP
• Katalina Marie Eubanks, NP
• Andrea Eudy Eudy, NP
• Randa Eury, NP
• Anterrio Evans

• Community/Behavioral Health Agency in Concord, NC
• Providers in Concord, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2025; 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.