1851399737 NPI number — WILSHIRE HEALTH AND COMMUNITY SERVICES, INC

Table of content: (NPI 1851399737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851399737 NPI number — WILSHIRE HEALTH AND COMMUNITY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILSHIRE HEALTH AND COMMUNITY SERVICES, INC
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:
WILSHIRE HOME HEALTH
Provider Other Organization Name Type Code:
3
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:
1851399737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3250 OCEAN PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 100-A
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90405-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-586-0710
Provider Business Mailing Address Fax Number:
310-586-0810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3250 OCEAN PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 100-A
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90405-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-586-0710
Provider Business Practice Location Address Fax Number:
310-586-0810
Provider Enumeration Date:
07/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
PATSY
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
310-586-0710

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  980001031 , 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: ZZZ09213Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HHA57741G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".