Provider Demographics
NPI: | 1265836878 |
---|---|
Name: | EMMANUEL HEALTHCARE, INC. |
Entity Type: | Organization |
Organization Name: | EMMANUEL HEALTHCARE, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CESAR |
Authorized Official - Middle Name: | YAMSON |
Authorized Official - Last Name: | MATA |
Authorized Official - Suffix: | II |
Authorized Official - Credentials: | LVN |
Authorized Official - Phone: | 917-478-5320 |
Mailing Address - Street 1: | 4510 PERALTA BLVD |
Mailing Address - Street 2: | STE 25 |
Mailing Address - City: | FREMONT |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94536-5755 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-894-4136 |
Mailing Address - Fax: | 510-358-2614 |
Practice Address - Street 1: | 4510 PERALTA BLVD |
Practice Address - Street 2: | STE 25 |
Practice Address - City: | FREMONT |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94536-5755 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-894-4136 |
Practice Address - Fax: | 510-358-2614 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-11 |
Last Update Date: | 2016-01-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 059671 | Medicare Oscar/Certification |