1477538858 NPI number — WESTERN HEALTH RESOURCES

Table of content: (NPI 1477538858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477538858 NPI number — WESTERN HEALTH RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN HEALTH RESOURCES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTERN HEALTH PRIVATE HOMECARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477538858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 DOUGLAS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-780-2480
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
591 CAMINO DE LA REINA
Provider Second Line Business Practice Location Address:
SUITE #1010 B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-293-6820
Provider Business Practice Location Address Fax Number:
619-692-3121
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WIEDEMANN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
916-781-4772

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  080000448 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HHA70271F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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