Provider Demographics
NPI:1699130294
Name:WILSHIRE HOME HEALTH INC
Entity type:Organization
Organization Name:WILSHIRE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER, CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-329-7051
Mailing Address - Street 1:3450 WILSHIRE BLVD STE 1126
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2217
Mailing Address - Country:US
Mailing Address - Phone:213-389-6557
Mailing Address - Fax:213-389-6511
Practice Address - Street 1:3450 WILSHIRE BLVD STE 1126
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2217
Practice Address - Country:US
Practice Address - Phone:213-389-6557
Practice Address - Fax:213-389-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000932251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225225626Medicare Oscar/Certification