NPIMap

Organization Active NPI

Western States Homehealth Care Agency Inc

Doing business as Western State Home Health Care,Inc.

  • Home Health Agency
  • Los Angeles, CA
National Provider Identifier
1962474387
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980001323 Issued in CA
Legal business name
WESTERN STATES HOMEHEALTH CARE AGENCY INC
Doing business as
Western State Home Health Care,Inc.
Practice address
5777 W Century Blvd Ste 610
Los Angeles, CA 90045-5600
Phone
(310) 672-4581
Fax
(310) 672-6586
NPI assigned
Feb 2, 2006
Last updated
Jan 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ephrem Tilahun
Title
Administrator/ C.F.O.
Phone
(310) 672-4581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980001323 CA Primary

Addresses

Primary practice location

5777 W Century Blvd Ste 610
Los Angeles, CA 90045-5600

Mailing address

5777 W Century Blvd Ste 610
Los Angeles, CA 90045-5600
Phone (310) 672-4581

Other identifiers 2

IdentifierTypeStateIssuer
HHA08097FMedicaidCA
ZZZ06223ZOtherBLUE SHIELD

Other names 1

  • Western State Home Health Care,Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080208000573 CA Part A Provider - Home Health Agency 6204919582 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962474387. Details of each certification follow.

Home health agency certification: CCN 058097

Legal name
WESTERN STATES HOMEHEALTH CARE AGENCY INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 22, 2002
Last certification
Mar 27, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 23, 2000 in CA
Enrollment address
5777 W Century Blvd
Ste 610
Los Angeles, CA 90045-5600

Care Compare: Home health agency

Medicare Care Compare
Listed as
Western States Homehealth Care Agency, IncCCN 058097 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Jan 22, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0981331Western States Homehealth5777 W Century Blvd Suite 610, Los Angeles, CA 90045Certificate of waiverDec 21, 2026

National Provider Directory

National Provider Directory

Locations

5777 W Century Blvd
Ste 600
Los Angeles, CA 90045

5777 W Century Blvd
Ste 610
Los Angeles, CA 90045
Phone (310) 672-4581

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ephrem Tilahun Individual Corporate OfficerCfo/Secretary Aug 23, 2000
W-2 Managing EmployeeAdministrator Aug 23, 2000 100%
Aziza Abdi Individual 5% Or Greater Direct Ownership InterestPresident Aug 23, 2000 100%
Corporate OfficerPresident Aug 23, 2000 100%
W-2 Managing EmployeePresident Sep 23, 2000 100%
Mercedes Patrica Farley Individual W-2 Managing EmployeeDirector of Patient Care Services May 15, 2024
Asad U Khaja Individual Contracted Managing EmployeeMedical Director Nov 12, 2021
Corporate DirectorMedical Director Nov 12, 2021

Practitioners & affiliated clinicians

Affiliated clinicians 16

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1962474387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5777 W CENTURY BLVD STE 610",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455600",
            "telephone_number": "310-672-4581",
            "fax_number": "310-672-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5777 W CENTURY BLVD STE 610",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455600",
            "telephone_number": "310-672-4581",
            "fax_number": "310-672-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN STATES HOMEHEALTH CARE AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "TILAHUN",
        "authorized_official_first_name": "EPHREM",
        "authorized_official_title_or_position": "ADMINISTRATOR/ C.F.O.",
        "authorized_official_telephone_number": "310-672-4581",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08097F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ06223Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western State Home Health Care,Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western State Home Health Care,Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.