MEDICARE: WELLHOUSE CARE, INC.

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	251G00000X	Community Based Hospice Care Agency		CA

General Provider Information

NPI Number	:	1548535370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLHOUSE CARE, INC.

Provider Business Mailing Address
First Line	:	11354 MOUNTAIN VIEW AVE
Second Line	:	SUITE D
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3855
Country	:	US
Telephone Number	:	951-237-3949
Fax Number	:

Provider Business Practice Location Address
First Line	:	11354 MOUNTAIN VIEW AVE
Second Line	:	SUITE D
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3855
Country	:	US
Telephone Number	:	951-237-3949
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR, CEO
Name	:	GENESIS PUNZALAN
Credential	:
Telephone Number	:	951-237-3949

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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