Provider Demographics
NPI:1245475011
Name:EXCELLENT HOME HEALTH CARE 11 INC
Entity type:Organization
Organization Name:EXCELLENT HOME HEALTH CARE 11 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-742-3828
Mailing Address - Street 1:6811 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1807
Mailing Address - Country:US
Mailing Address - Phone:201-861-8500
Mailing Address - Fax:201-861-8900
Practice Address - Street 1:6811 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:GUTTENGBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-1807
Practice Address - Country:US
Practice Address - Phone:201-861-8500
Practice Address - Fax:201-861-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0047201251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health