Provider Demographics
NPI:1023316130
Name:NICE HOME HEALTH AGENCY
Entity type:Organization
Organization Name:NICE HOME HEALTH AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:EKWELUM
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:510-691-1326
Mailing Address - Street 1:7710 BRENTWOOD BLVD
Mailing Address - Street 2:SUITE B1 SUNSET PLAZA
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1043
Mailing Address - Country:US
Mailing Address - Phone:510-691-1326
Mailing Address - Fax:925-418-4391
Practice Address - Street 1:7710 BRENTWOOD BLVD
Practice Address - Street 2:SUITE B1 SUNSET PLAZA
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1043
Practice Address - Country:US
Practice Address - Phone:510-691-1326
Practice Address - Fax:925-418-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584749251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health