Provider Demographics
NPI:1720208788
Name:WIGGINS HOME #3
Entity Type:Organization
Organization Name:WIGGINS HOME #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-781-3669
Mailing Address - Street 1:1012 VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5550
Mailing Address - Country:US
Mailing Address - Phone:559-781-3669
Mailing Address - Fax:559-791-0673
Practice Address - Street 1:677 SIERRA ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5543
Practice Address - Country:US
Practice Address - Phone:559-783-0732
Practice Address - Fax:559-791-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315P00000X
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities