Provider Demographics
NPI:1013038553
Name:WESTSIDE HOME CARE AGENCY, LTD.
Entity Type:Organization
Organization Name:WESTSIDE HOME CARE AGENCY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WAGENHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-637-7215
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:80 CLINTON ST.
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-0347
Mailing Address - Country:US
Mailing Address - Phone:585-637-7215
Mailing Address - Fax:585-637-8913
Practice Address - Street 1:80 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1841
Practice Address - Country:US
Practice Address - Phone:585-637-7215
Practice Address - Fax:585-637-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9898L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health