Provider Demographics
NPI:1801391396
Name:EXCELLENT HOME HEALTH CARE INC
Entity type:Organization
Organization Name:EXCELLENT HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:640 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1984
Mailing Address - Country:US
Mailing Address - Phone:973-742-3828
Mailing Address - Fax:973-742-2848
Practice Address - Street 1:640 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1984
Practice Address - Country:US
Practice Address - Phone:973-742-3828
Practice Address - Fax:973-742-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0485161Medicaid