MEDICARE: WESTERN STATES HOMEHEALTH CARE AGENCY INC

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	980001323	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
2	ZZZ06223Z	OTHER		BLUE SHIELD

General Provider Information

NPI Number	:	1962474387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN STATES HOMEHEALTH CARE AGENCY INC

Provider Business Mailing Address
First Line	:	5777 W CENTURY BLVD STE 610
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5600
Country	:	US
Telephone Number	:	310-672-4581
Fax Number	:	310-672-6586

Provider Business Practice Location Address
First Line	:	5777 W CENTURY BLVD STE 610
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5600
Country	:	US
Telephone Number	:	310-672-4581
Fax Number	:	310-672-6586

Authorized Official
Title or Position	:	ADMINISTRATOR/ C.F.O.
Name	:	MR. EPHREM TILAHUN
Credential	:
Telephone Number	:	310-672-4581

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	01/23/2020

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