Basic Information
| Provider Information | |||||||||
| NPI: | 1033397336 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTERN HEALTH RESOURCES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVENTIST HEALTH HOME CARE AND HOSPICE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 DOUGLAS BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956613804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167802480 | ||||||||
| FaxNumber: | 9167812460 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 KINGS COUNTY DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932305953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595853425 | ||||||||
| FaxNumber: | 5595853420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 11/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | WIEDEMANN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9167802480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 040000346 | CA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | HHA07477F | 05 | CA | MEDICAID |