Healthcare Provider Details

I. General information

NPI: 1538492830
Provider Name (Legal Business Name): AWHC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL CIR
WESTMINSTER CA
92683-3953
US

IV. Provider business mailing address

28202 CABOT RD 412
LAGUNA NIGUEL CA
92677-1222
US

V. Phone/Fax

Practice location:
  • Phone: 657-464-3781
  • Fax: 714-388-3632
Mailing address:
  • Phone: 949-347-7100
  • Fax: 714-388-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY JARED BRADSHAW
Title or Position: SECRETARY/VP OPERATIONS
Credential:
Phone: 657-464-3781