Provider Demographics
NPI:1043066681
Name:ETERNAL CORNERSTONE, LLC
Entity type:Organization
Organization Name:ETERNAL CORNERSTONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOANNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-389-7227
Mailing Address - Street 1:403 OCEAN JASPER DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-8089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 OCEAN JASPER DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-8089
Practice Address - Country:US
Practice Address - Phone:970-389-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care