Eternal Life Services Corp

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

ETERNAL LIFE SERVICES CORP

Practice address

15552 SW 11TH Ter
Miami, FL 33194-2789

Phone

(305) 753-6270

NPI assigned

Oct 29, 2019

Organization subpart

No

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

Authorized official

Name

Gustavo Rodriguez

Title

Ceo

Phone

(305) 753-6270

Specialties & licenses 2

Addresses

Tax ID family

Eternal Life Services Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eternal Life Services Corp

  • Home Health Agency
  • Miramar, FL
  • NPI 1649003336
  NPD tax ID

Locations

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

{
    "created_epoch": "1572307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572307200000",
    "number": "1700420205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15552 SW 11TH TER",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331942789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15552 SW 11TH TER",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331942789",
            "telephone_number": "305-753-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNAL LIFE SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-29",
        "last_updated": "2019-10-29",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-753-6270"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohamed Hamdan Mohamed Etafy, MD
• Etairos Health Inc
• Elias Georges Eter, M.D.
• Eterna Vida Medical Center LLC
• Eternal Life Medical Center LLC
• Eternity Community Mental Health Corp
• Eternity Estates Corp.
• Eternity Life Care LLC
• Eternity Lives
• Eternity Medical Group Corp

• Developmental Disabilities Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; 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.