Provider Demographics
NPI:1114161445
Name:EXCELLENCE HOME HEALTH PROVIDER INC
Entity Type:Organization
Organization Name:EXCELLENCE HOME HEALTH PROVIDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBBIE
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:714-571-5551
Mailing Address - Street 1:4050 KATELLA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3477
Mailing Address - Country:US
Mailing Address - Phone:714-571-5551
Mailing Address - Fax:714-571-5531
Practice Address - Street 1:4050 KATELLA AVE STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3477
Practice Address - Country:US
Practice Address - Phone:714-571-5551
Practice Address - Fax:714-571-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health