MEDICARE: EXCELLENT HOME HEALTH CARE 11 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	HP0047201	NJ

General Provider Information

NPI Number	:	1245475011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENT HOME HEALTH CARE 11 INC

Provider Business Mailing Address
First Line	:	6811 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1807
Country	:	US
Telephone Number	:	201-861-8500
Fax Number	:	201-861-8900

Provider Business Practice Location Address
First Line	:	6811 BERGENLINE AVE
Second Line	:
City	:	GUTTENGBERG
State	:	NJ
Zip	:	07093-1807
Country	:	US
Telephone Number	:	201-861-8500
Fax Number	:	201-861-8900

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS WILDA DIAZ
Credential	:
Telephone Number	:	973-742-3828

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	12/10/2008

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