Provider Demographics
NPI:1265836878
Name:EMMANUEL HEALTHCARE, INC.
Entity type:Organization
Organization Name:EMMANUEL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:YAMSON
Authorized Official - Last Name:MATA
Authorized Official - Suffix:II
Authorized Official - Credentials:LVN
Authorized Official - Phone:917-478-5320
Mailing Address - Street 1:4510 PERALTA BLVD
Mailing Address - Street 2:STE 25
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5755
Mailing Address - Country:US
Mailing Address - Phone:510-894-4136
Mailing Address - Fax:510-358-2614
Practice Address - Street 1:4510 PERALTA BLVD
Practice Address - Street 2:STE 25
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5755
Practice Address - Country:US
Practice Address - Phone:510-894-4136
Practice Address - Fax:510-358-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059671Medicare Oscar/Certification