Provider Demographics
NPI:1336490655
Name:WESTERN HEALTH RESOURCES
Entity Type:Organization
Organization Name:WESTERN HEALTH RESOURCES
Other - Org Name:ADVENTIST HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-406-1430
Mailing Address - Street 1:1 ADVENTIST HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3266
Mailing Address - Country:US
Mailing Address - Phone:916-406-1430
Mailing Address - Fax:
Practice Address - Street 1:821 SAINT HELENA HWY S STE 205&207
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2266
Practice Address - Country:US
Practice Address - Phone:707-967-5770
Practice Address - Fax:707-963-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057138Medicare Oscar/Certification