Provider Demographics
NPI:1831131184
Name:WESTERN HEALTH RESOURCES
Entity Type:Organization
Organization Name:WESTERN HEALTH RESOURCES
Other - Org Name:COMMUNITY PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME CARE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209916-781-4772
Mailing Address - Street 1:177 FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4809
Mailing Address - Country:US
Mailing Address - Phone:209-536-3820
Mailing Address - Fax:209-536-3540
Practice Address - Street 1:177 FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4809
Practice Address - Country:US
Practice Address - Phone:209-536-3820
Practice Address - Fax:209-536-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
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
CAHHA70279FMedicaid