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General NPI Number Information
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NPI Number | 1962474387
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Entity Type | Organization
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Legal Business Name | WESTERN STATES HOMEHEALTH CARE AGENCY INC
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 5777 W CENTURY BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90045-5600
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Country | US
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Telephone | 310-672-4581
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Fax | 310-672-6586
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Provider Business Mailing Address
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Address Line | 5777 W CENTURY BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90045-5600
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Country | US
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Telephone | 310-672-4581
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Fax | 310-672-6586
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Authorized Official
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Title or Position | ADMINISTRATOR/ C.F.O.
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Name | MR. EPHREM TILAHUN
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Credential |
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Telephone | 310-672-4581
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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 | 980001323
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License Number State | CA
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