Provider Demographics
NPI:1386351161
Name:PREMIER HOMECARE ANGELS, INC
Entity type:Organization
Organization Name:PREMIER HOMECARE ANGELS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDD
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-331-6970
Mailing Address - Street 1:909 MARINA VILLAGE PKWY # 682
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1048
Mailing Address - Country:US
Mailing Address - Phone:510-331-6970
Mailing Address - Fax:
Practice Address - Street 1:1516 OAK ST STE 105
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2953
Practice Address - Country:US
Practice Address - Phone:510-227-5391
Practice Address - Fax:877-572-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care