Provider Demographics
NPI:1578674016
Name:WESLEY RETIREMENT SERVICES, INC
Entity Type:Organization
Organization Name:WESLEY RETIREMENT SERVICES, INC
Other - Org Name:HERITAGE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ED
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-243-1850
Mailing Address - Street 1:1200 BROOKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2304
Mailing Address - Country:US
Mailing Address - Phone:712-243-1850
Mailing Address - Fax:
Practice Address - Street 1:1200 BROOKRIDGE CIR
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-2304
Practice Address - Country:US
Practice Address - Phone:712-243-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEY RETIREMENT SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0055310400000X
IA150075314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801845Medicaid
IA165561Medicare ID - Type Unspecified