Basic Information
| Provider Information | |||||||||
| NPI: | 1467630764 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTERN HEALTH RESOURCES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVENTIST HEALTH HOME CARE AND HOSPICE SERVICES MENDOCINO COUNTY | ||||||||
| 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: | 100 SAN HEDRIN CIR | ||||||||
| Address2: | |||||||||
| City: | WILLITS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954908753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074591818 | ||||||||
| FaxNumber: | 7074599298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | TRUDY | ||||||||
| AuthorizedOfficialMiddleName: | DELYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7074591818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 010000256 | CA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | HHA57283F | 05 | CA | MEDICAID |