=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336463306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL HOME HEALTH AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2010
-----------------------------------------------------
Last Update Date | 04/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3140 DE LA CRUZ BLVD STE 200
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-855-9200
-----------------------------------------------------
Fax | 408-855-9210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3140 DE LA CRUZ BLVD. STE. 200
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-855-9200
-----------------------------------------------------
Fax | 408-855-9210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. RUTH ARCIAGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-209-6390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------