Provider Demographics
NPI:1851699813
Name:EMANNUEL CARE HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:EMANNUEL CARE HOME HEALTH AGENCY, LLC
Other - Org Name:EMANNUEL CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MILIAKERE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-885-1926
Mailing Address - Street 1:22245 MAIN ST
Mailing Address - Street 2:SUITE# 104
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4028
Mailing Address - Country:US
Mailing Address - Phone:510-885-1926
Mailing Address - Fax:510-886-8418
Practice Address - Street 1:22245 MAIN ST
Practice Address - Street 2:SUITE# 104
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4028
Practice Address - Country:US
Practice Address - Phone:510-885-1926
Practice Address - Fax:510-886-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001874251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550001874OtherSTATE OF CA, DEPARTMENT OF PUBLIC HEALTH