Provider Demographics
NPI:1407814064
Name:WESTERN HOME CARE, LLC
Entity Type:Organization
Organization Name:WESTERN HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-252-5000
Mailing Address - Street 1:1626 S EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6200
Mailing Address - Country:US
Mailing Address - Phone:602-252-5000
Mailing Address - Fax:602-323-5070
Practice Address - Street 1:4035 E POST RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3992
Practice Address - Country:US
Practice Address - Phone:702-914-7337
Practice Address - Fax:702-914-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NVPH02658332BP3500X, 3336H0001X
NVMP00196332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504717Medicaid
NV100504717Medicaid