=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699130294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILSHIRE HOME HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2015
-----------------------------------------------------
Last Update Date | 12/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3450 WILSHIRE BLVD STE 1126
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-389-6557
-----------------------------------------------------
Fax | 213-389-6511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3450 WILSHIRE BLVD STE 1126
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-389-6557
-----------------------------------------------------
Fax | 213-389-6511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLER, CONSULTANT
-----------------------------------------------------
Name | MRS. MARIA MEDINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-329-7051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 550000932
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------