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General NPI Number Information
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NPI Number | 1013038553
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Entity Type | Organization
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Legal Business Name | WESTSIDE HOME CARE AGENCY, LTD.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 80 CLINTON ST
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City | BROCKPORT
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State | NY
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Zip | 14420-1841
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Country | US
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Telephone | 585-637-7215
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Fax | 585-637-8913
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Provider Business Mailing Address
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Address Line | PO BOX 347 80 CLINTON ST.
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City | BROCKPORT
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State | NY
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Zip | 14420-0347
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Country | US
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Telephone | 585-637-7215
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Fax | 585-637-8913
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Authorized Official
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Title or Position | VP
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Name | MR. DAVID JOHN WAGENHAUSER
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Credential |
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Telephone | 585-637-7215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 9898L001
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License Number State | NY
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