MEDICARE: WELLNESS HOME HEALTH AGENCY LLC

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	:	1376784009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	1704 SPRINGS RD
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-5474
Country	:	US
Telephone Number	:	707-643-2879
Fax Number	:	707-643-4028

Provider Business Practice Location Address
First Line	:	1704 SPRINGS RD SUITE B
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-5475
Country	:	US
Telephone Number	:	707-643-2879
Fax Number	:	707-643-4028

Authorized Official
Title or Position	:	CEO
Name	:	MR. EMERLINO R. MANAID
Credential	:
Telephone Number	:	707-643-2100

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	09/17/2009

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