MEDICARE: WESTERN HEALTH PRIVATE HOMECARE

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	251E00000X	Home Health Agency	08000048	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043750516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN HEALTH PRIVATE HOMECARE

Provider Business Mailing Address
First Line	:	5838 EDISON PL STE 201
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-5520
Country	:	US
Telephone Number	:	619-865-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 CAMINO DE LA REINA STE 1010
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3112
Country	:	US
Telephone Number	:	619-865-2400
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BRIAN TWIGGER
Credential	:
Telephone Number	:	619-865-2400

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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