Provider Demographics
NPI:1326648809
Name:WESLEY GLEN RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:WESLEY GLEN RETIREMENT COMMUNITY
Other - Org Name:WESLEY GLEN ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BILLING & COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-396-4931
Mailing Address - Street 1:5155 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1694
Mailing Address - Country:US
Mailing Address - Phone:614-888-7492
Mailing Address - Fax:614-436-3740
Practice Address - Street 1:5155 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1694
Practice Address - Country:US
Practice Address - Phone:614-888-7492
Practice Address - Fax:614-436-3740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEY GLEN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672611Medicaid