| Eternal Haven Llc | |
|
4111 Zebulon Ave Sw Concord NC 28027-9209 | |
| (704) 796-1156 | |
| Not Available |
| Full Name | Eternal Haven Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4111 Zebulon Ave Sw, Concord, North Carolina |
| Authorized Official Name and Position | Brandon Blasse (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7047961156 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eternal Haven Llc 4111 Zebulon Ave Sw Concord NC 28027-9209 Ph: (704) 796-1156 | Eternal Haven Llc 4111 Zebulon Ave Sw Concord NC 28027-9209 Ph: (704) 796-1156 |
| NPI Number | 1184489460 |
|---|---|
| Provider Enumeration Date | 02/16/2024 |
| Last Update Date | 10/28/2025 |
| Certification Date | 10/28/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184489460 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
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