Provider Demographics
NPI:1447209283
Name:WESTERN HOME CARE LLC
Entity Type:Organization
Organization Name:WESTERN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-246-3950
Mailing Address - Street 1:1626 S. EDWARDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281
Mailing Address - Country:US
Mailing Address - Phone:702-914-7337
Mailing Address - Fax:702-914-7304
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:702-262-5500
Practice Address - Fax:702-262-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3731HHA-5251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297103Medicare PIN