Provider Demographics
NPI:1043750516
Name:WESTERN HEALTH PRIVATE HOMECARE
Entity Type:Organization
Organization Name:WESTERN HEALTH PRIVATE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-865-2400
Mailing Address - Street 1:5838 EDISON PL STE 201
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-5520
Mailing Address - Country:US
Mailing Address - Phone:619-865-2400
Mailing Address - Fax:
Practice Address - Street 1:591 CAMINO DE LA REINA STE 1010
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3112
Practice Address - Country:US
Practice Address - Phone:619-865-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN HEALTH RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08000048251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70271FMedicaid