MEDICARE: EXCELLENT HOME HEALTH AGENCY 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

General Provider Information

NPI Number	:	1306402847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENT HOME HEALTH AGENCY INC

Provider Business Mailing Address
First Line	:	4220 E LOS ANGELES AVE STE 102
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3305
Country	:	US
Telephone Number	:	818-935-1687
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 E LOS ANGELES AVE STE 102
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3305
Country	:	US
Telephone Number	:	818-935-1687
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. RUZANNA ADAMYAN
Credential	:
Telephone Number	:	818-935-1687

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	05/09/2019

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