MEDICARE: AWHC,LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1538492830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWHC,LLC

Provider Business Mailing Address
First Line	:	28202 CABOT RD
Second Line	:	412
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-1222
Country	:	US
Telephone Number	:	949-347-7100
Fax Number	:	714-388-3632

Provider Business Practice Location Address
First Line	:	240 HOSPITAL CIR
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3953
Country	:	US
Telephone Number	:	657-464-3781
Fax Number	:	714-388-3632

Authorized Official
Title or Position	:	SECRETARY/VP OPERATIONS
Name	:	MR. JEFFREY JARED BRADSHAW
Credential	:
Telephone Number	:	657-464-3781

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	12/14/2009

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