MEDICARE: EXCELLENCE HOME HEALTH CARE AGENCY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	240000872	CA

General Provider Information

NPI Number	:	1568556801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE HOME HEALTH CARE AGENCY, INC.

Provider Business Mailing Address
First Line	:	11760 CENTRAL AVE
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-1900
Country	:	US
Telephone Number	:	877-591-1731
Fax Number	:	909-591-6031

Provider Business Practice Location Address
First Line	:	11760 CENTRAL AVE
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-6499
Country	:	US
Telephone Number	:	877-591-1731
Fax Number	:	909-591-6031

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THI ANH DOAN
Credential	:
Telephone Number	:	877-591-1731

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/20/2010

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