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General NPI Number Information
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NPI Number | 1245475011
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Entity Type | Organization
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Legal Business Name | EXCELLENT HOME HEALTH CARE 11 INC
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 6811 BERGENLINE AVE
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City | GUTTENGBERG
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State | NJ
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Zip | 07093-1807
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Country | US
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Telephone | 201-861-8500
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Fax | 201-861-8900
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Provider Business Mailing Address
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Address Line | 6811 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1807
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Country | US
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Telephone | 201-861-8500
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Fax | 201-861-8900
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS WILDA DIAZ
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Credential |
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Telephone | 973-742-3828
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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 | HP0047201
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License Number State | NJ
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