Provider Demographics
NPI:1679576607
Name:EMERALD HOME HEALTH INC
Entity Type:Organization
Organization Name:EMERALD HOME HEALTH INC
Other - Org Name:GENESIS HOME HEALTH INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTIANNE NIGEL
Authorized Official - Middle Name:ABRENICA
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN-BC
Authorized Official - Phone:805-864-9311
Mailing Address - Street 1:5775 E. LOS ANGELES AVENUE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5213
Mailing Address - Country:US
Mailing Address - Phone:805-864-9311
Mailing Address - Fax:805-864-9312
Practice Address - Street 1:5775 E. LOS ANGELES AVENUE
Practice Address - Street 2:SUITE 232
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5213
Practice Address - Country:US
Practice Address - Phone:805-864-9311
Practice Address - Fax:805-864-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000651251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57266GMedicaid
CA557266Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER