Provider Demographics
NPI:1376784009
Name:WELLNESS HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:WELLNESS HOME HEALTH AGENCY LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMERLINO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-643-2100
Mailing Address - Street 1:1704 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5474
Mailing Address - Country:US
Mailing Address - Phone:707-643-2879
Mailing Address - Fax:707-643-4028
Practice Address - Street 1:1704 SPRINGS RD SUITE B
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5475
Practice Address - Country:US
Practice Address - Phone:707-643-2879
Practice Address - Fax:707-643-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health