Eternity Hospice and Palliative Care, PLLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

HSPC7945 Issued in AZ

Legal business name

ETERNITY HOSPICE AND PALLIATIVE CARE, PLLC

Practice address

4140 N 108TH Ave Ste 101a
Phoenix, AZ 85037-5466

Phone

(623) 203-6678

Fax

(888) 778-1251

NPI assigned

Oct 28, 2014

Last updated

Apr 12, 2021By 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

Amabel Baltar Bongoyan, BSN, RN

Title

Administrator/Don

Phone

(602) 374-6878

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396140778. Details of each certification follow.

• CCN 031667 Hospice · Active · Details

Hospice certification: CCN 031667

Legal name

ETERNITY HOSPICE AND PALLIATIVE CARE, PLLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 26, 2017

Last certification

Jun 26, 2020

Ownership / control type

Other

Organization structure

LLCProprietary

Incorporated

Nov 8, 2012 in AZ

Enrollment address

4140 N 108TH Ave
Ste 101a
Phoenix, AZ 85037-5466

Listed as

Eternity Hospice & Palliative CareCCN 031667 · All quality measures

Ownership

Other

Certified

Jun 26, 2017

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Richard W Moos, MD PC

  • Obstetrics & Gynecology Physician
  • Scottsdale, AZ
  • NPI 1033100821

  Contracted Managing Employee

  CMS ownership

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1396140778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 N 108TH AVE STE 101A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375466",
            "telephone_number": "623-203-6678",
            "fax_number": "888-778-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4140 N 108TH AVE STE 101A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375466",
            "telephone_number": "623-203-6678",
            "fax_number": "888-778-1251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNITY HOSPICE AND PALLIATIVE CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2021-04-12",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "BONGOYAN",
        "authorized_official_first_name": "AMABEL",
        "authorized_official_middle_name": "BALTAR",
        "authorized_official_title_or_position": "ADMINISTRATOR/DON",
        "authorized_official_telephone_number": "602-374-6878",
        "authorized_official_credential": "BSN, RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AZ",
            "license": "HSPC6394",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AZ",
            "license": "HSPC7945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Etchells, PA-C
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• Eternal Pathway LLC
• Eternity Home Health Care LLC (Eternity Home Health Care)
• Eternity Services LLC
• Cristina Rose Etienne, P.A.
• Gregory C Etienne, PA
• Samantha Valerie Etienne, MD
• Samuel Lucas Etling

• Community Based Hospice Care Agency in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.