Provider Demographics
NPI:1043869944
Name:WESLEY VILLAGE, INC
Entity Type:Organization
Organization Name:WESLEY VILLAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF WESLEY HOME HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-833-2613
Mailing Address - Street 1:1200 EAST GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-833-2613
Mailing Address - Fax:309-837-7500
Practice Address - Street 1:1200 EAST GRANT STREET
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-833-2613
Practice Address - Fax:309-837-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty