Provider Demographics
NPI:1588648380
Name:WESTERN HEALTH RESOURCES
Entity Type:Organization
Organization Name:WESTERN HEALTH RESOURCES
Other - Org Name:WESTERN HEALTH HOMECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
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:916-780-2480
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:916-781-2460
Practice Address - Street 1:591 CAMINO DE LA REINA
Practice Address - Street 2:SUITE 1010 A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3102
Practice Address - Country:US
Practice Address - Phone:619-293-6800
Practice Address - Fax:619-692-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000085251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07114IMedicaid
CA057114Medicare ID - Type Unspecified