Provider Demographics
NPI:1477538858
Name:WESTERN HEALTH RESOURCES
Entity Type:Organization
Organization Name:WESTERN HEALTH RESOURCES
Other - Org Name:WESTERN HEALTH PRIVATE HOMECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:WIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:916-781-4772
Mailing Address - Street 1:2100 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3804
Mailing Address - Country:US
Mailing Address - Phone:916-780-2480
Mailing Address - Fax:
Practice Address - Street 1:591 CAMINO DE LA REINA
Practice Address - Street 2:SUITE #1010 B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3102
Practice Address - Country:US
Practice Address - Phone:619-293-6820
Practice Address - Fax:619-692-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000448251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70271FMedicaid