Provider Demographics
NPI:1407933245
Name:THE SHORES AT WESLEY MANOR
Entity Type:Organization
Organization Name:THE SHORES AT WESLEY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-922-9802
Mailing Address - Street 1:3311 STATE ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3440
Mailing Address - Country:US
Mailing Address - Phone:732-922-9802
Mailing Address - Fax:732-922-9804
Practice Address - Street 1:2201 BAY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-2568
Practice Address - Country:US
Practice Address - Phone:609-399-8505
Practice Address - Fax:609-391-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ314000000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7700504Medicaid
NJ4471903Medicaid
NJ7700504Medicaid
NJ7700504Medicaid