Provider Demographics
NPI:1609863539
Name:WESLEY RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:WESLEY RETIREMENT SERVICES, INC.
Other - Org Name:HALCYON HOUSE, A WESLEYLIFE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, CPA
Authorized Official - Phone:319-653-8313
Mailing Address - Street 1:1015 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1126
Mailing Address - Country:US
Mailing Address - Phone:319-653-7264
Mailing Address - Fax:319-653-8383
Practice Address - Street 1:1015 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1126
Practice Address - Country:US
Practice Address - Phone:319-653-7264
Practice Address - Fax:319-653-8383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEY RETIREMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-05
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA112462163WA2000X
IA920323314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801753Medicaid
IA0252379Medicaid
IA0891523Medicaid
IA0801753Medicaid