Provider Demographics
NPI:1336474915
Name:HEARTHSTONE, A MINISTRY OF WESLEYLIFE, LLC
Entity Type:Organization
Organization Name:HEARTHSTONE, A MINISTRY OF WESLEYLIFE, LLC
Other - Org Name:PELLA ELDER CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:KRETZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-271-6791
Mailing Address - Street 1:413 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1288
Mailing Address - Country:US
Mailing Address - Phone:641-628-9857
Mailing Address - Fax:641-628-9887
Practice Address - Street 1:413 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1288
Practice Address - Country:US
Practice Address - Phone:641-628-9857
Practice Address - Fax:641-628-9887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEY RETIREMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-15
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA631119313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165598Medicare Oscar/Certification