MEDICARE: WESTERN HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	3731HHA-5	NV

General Provider Information

NPI Number	:	1447209283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN HOME CARE LLC

Provider Business Mailing Address
First Line	:	1626 S. EDWARDS DRIVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281
Country	:	US
Telephone Number	:	702-914-7337
Fax Number	:	702-914-7304

Provider Business Practice Location Address
First Line	:	4035 E POST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3992
Country	:	US
Telephone Number	:	702-262-5500
Fax Number	:	702-262-9997

Authorized Official
Title or Position	:	A/R MANAGER
Name	:	MR. ROBERT COSTON
Credential	:
Telephone Number	:	480-246-3950

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	09/04/2007

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