Provider Demographics
NPI:1205676343
Name:WP HOME CARE LLC
Entity type:Organization
Organization Name:WP HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATSARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANTHARASETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-722-9269
Mailing Address - Street 1:6305 NOBURY CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8567
Mailing Address - Country:US
Mailing Address - Phone:657-722-9269
Mailing Address - Fax:
Practice Address - Street 1:11949 TRIBUTARY WAY
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-2764
Practice Address - Country:US
Practice Address - Phone:657-722-9269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility