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General NPI Number Information
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NPI Number | 1114161445
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Entity Type | Organization
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Legal Business Name | EXCELLENCE HOME HEALTH PROVIDER INC
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 4050 KATELLA AVE STE 204
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3477
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Country | US
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Telephone | 714-571-5551
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Fax | 714-571-5531
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Provider Business Mailing Address
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Address Line | 4050 KATELLA AVE STE 204
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3477
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Country | US
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Telephone | 714-571-5551
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Fax | 714-571-5531
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RUBBIE SUSANNE MANALO
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Credential | L.V.N.
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Telephone | 714-571-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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