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General NPI Number Information
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NPI Number | 1265836878
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Entity Type | Organization
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Legal Business Name | EMMANUEL HEALTHCARE, INC.
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Dates
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Enumeration Date | 10/11/2014
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 4510 PERALTA BLVD STE 25
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City | FREMONT
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State | CA
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Zip | 94536-5755
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Country | US
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Telephone | 510-894-4136
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Fax | 510-358-2614
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Provider Business Mailing Address
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Address Line | 4510 PERALTA BLVD STE 25
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City | FREMONT
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State | CA
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Zip | 94536-5755
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Country | US
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Telephone | 510-894-4136
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Fax | 510-358-2614
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CESAR YAMSON MATA II
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Credential | LVN
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Telephone | 917-478-5320
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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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