Provider Demographics
NPI:1568556801
Name:EXCELLENCE HOME HEALTH CARE AGENCY, INC.
Entity Type:Organization
Organization Name:EXCELLENCE HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THI
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-591-1731
Mailing Address - Street 1:11760 CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1900
Mailing Address - Country:US
Mailing Address - Phone:877-591-1731
Mailing Address - Fax:909-591-6031
Practice Address - Street 1:11760 CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-6499
Practice Address - Country:US
Practice Address - Phone:877-591-1731
Practice Address - Fax:909-591-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000872251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058290Medicare ID - Type UnspecifiedPROVIDER NUMBER