Provider Demographics
NPI:1679601116
Name:WESLEYAN HOMES OF INDIANA, INC.
Entity Type:Organization
Organization Name:WESLEYAN HOMES OF INDIANA, INC.
Other - Org Name:SUMMERFIELD HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-944-8285
Mailing Address - Street 1:580 LONG HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120-8531
Practice Address - Country:US
Practice Address - Phone:765-795-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060004151314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100291250Medicaid
IN100291250Medicaid