Provider Demographics
NPI:1437943909
Name:EMINENCE HOME CENTER INC.
Entity type:Organization
Organization Name:EMINENCE HOME CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-770-0324
Mailing Address - Street 1:11451 DANUBE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4326
Mailing Address - Country:US
Mailing Address - Phone:818-770-0324
Mailing Address - Fax:
Practice Address - Street 1:11451 DANUBE AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4326
Practice Address - Country:US
Practice Address - Phone:818-770-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home