Provider Demographics
NPI:1538492830
Name:AWHC,LLC
Entity Type:Organization
Organization Name:AWHC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-464-3781
Mailing Address - Street 1:28202 CABOT RD
Mailing Address - Street 2:412
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1222
Mailing Address - Country:US
Mailing Address - Phone:949-347-7100
Mailing Address - Fax:714-388-3632
Practice Address - Street 1:240 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3953
Practice Address - Country:US
Practice Address - Phone:657-464-3781
Practice Address - Fax:714-388-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056271Medicare Oscar/Certification