Provider Demographics
NPI:1346338803
Name:WESLEY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:WESLEY COMMUNITY SERVICES
Other - Org Name:WESLEY AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-288-3334
Mailing Address - Street 1:P.O. BOX 7192
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-7192
Mailing Address - Country:US
Mailing Address - Phone:515-288-3334
Mailing Address - Fax:515-288-4740
Practice Address - Street 1:944 18TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1152
Practice Address - Country:US
Practice Address - Phone:515-288-3334
Practice Address - Fax:515-288-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672956Medicaid
IA167295OtherHUMANA GOLD
IA67295OtherWELLMARK BC/BS
IA0672956Medicaid