Provider Demographics
NPI:1578581518
Name:WESTERN HOME CARE, INC.
Entity Type:Organization
Organization Name:WESTERN HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPCS/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-522-1204
Mailing Address - Street 1:6131 ORANGETHORPE AVE
Mailing Address - Street 2:STE 480
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4916
Mailing Address - Country:US
Mailing Address - Phone:714-522-1204
Mailing Address - Fax:714-522-1205
Practice Address - Street 1:6131 ORANGETHORPE AVE STE 480
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4916
Practice Address - Country:US
Practice Address - Phone:714-522-1204
Practice Address - Fax:714-522-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08077GMedicaid
CAHHA08077GMedicaid