Provider Demographics
NPI:1235137738
Name:WILSHIRE HEALTH AND COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:WILSHIRE HEALTH AND COMMUNITY SERVICES, INC.
Other - Org Name:WILSHIRE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-782-8600
Mailing Address - Street 1:277 SOUTH ST
Mailing Address - Street 2:SUITE W
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5039
Mailing Address - Country:US
Mailing Address - Phone:805-782-8600
Mailing Address - Fax:805-782-6981
Practice Address - Street 1:277 SOUTH ST
Practice Address - Street 2:SUITE W
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5039
Practice Address - Country:US
Practice Address - Phone:805-782-8600
Practice Address - Fax:805-782-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000487251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08079FMedicaid
CAZZZ615507OtherMEDICAL NUMBER
CAHHA08079FMedicaid