Provider Demographics
NPI:1609321108
Name:EMMANUEL HEALTHCARE SOUTH BAY, INC.
Entity Type:Organization
Organization Name:EMMANUEL HEALTHCARE SOUTH BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:JAVELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-684-4327
Mailing Address - Street 1:800 CHARCOT AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2211
Mailing Address - Country:US
Mailing Address - Phone:408-684-4327
Mailing Address - Fax:408-684-4329
Practice Address - Street 1:800 CHARCOT AVE
Practice Address - Street 2:STE 113
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2211
Practice Address - Country:US
Practice Address - Phone:408-684-4327
Practice Address - Fax:408-684-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health