MEDICARE: EMERALD HOME HEALTH 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
2	251E00000X	Home Health Agency	980000651	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679576607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD HOME HEALTH INC

Provider Business Mailing Address
First Line	:	5775 E LOS ANGELES AVE STE 232
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-5215
Country	:	US
Telephone Number	:	805-864-9311
Fax Number	:	805-864-9312

Provider Business Practice Location Address
First Line	:	5775 E. LOS ANGELES AVENUE
Second Line	:	SUITE 232
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-5213
Country	:	US
Telephone Number	:	805-864-9311
Fax Number	:	805-864-9312

Authorized Official
Title or Position	:	ADMINISTRATOR/PRESIDENT
Name	:	MRS. KRYSTIANNE NIGEL ABRENICA KENNEDY
Credential	:	MSN, RN-BC
Telephone Number	:	805-864-9311

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/26/2025

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Directions to “EMERALD HOME HEALTH INC ” Practice Location

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