Provider Demographics
NPI:1073565826
Name:WESLEY RIDGE,INC
Entity Type:Organization
Organization Name:WESLEY RIDGE,INC
Other - Org Name:WESLEY RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:614-396-4813
Mailing Address - Street 1:2225 SR 256
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9501
Mailing Address - Country:US
Mailing Address - Phone:614-396-4813
Mailing Address - Fax:614-436-3740
Practice Address - Street 1:2225 SR 256
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9501
Practice Address - Country:US
Practice Address - Phone:614-396-4813
Practice Address - Fax:614-436-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility