Provider Demographics
NPI:1457612624
Name:WIGGINS HOMES
Entity type:Organization
Organization Name:WIGGINS HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ELYSIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-350-0141
Mailing Address - Street 1:2487 CRICKELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-6944
Mailing Address - Country:US
Mailing Address - Phone:559-350-0141
Mailing Address - Fax:559-789-9565
Practice Address - Street 1:675 N JAYE ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2163
Practice Address - Country:US
Practice Address - Phone:559-783-1821
Practice Address - Fax:559-791-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000308315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities