Provider Demographics
NPI:1831310143
Name:THE WESLEY
Entity Type:Organization
Organization Name:THE WESLEY
Other - Org Name:THE WESLEY AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MS
Authorized Official - Phone:410-324-2400
Mailing Address - Street 1:1107 KENILWORTH DR STE 312
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2135
Mailing Address - Country:US
Mailing Address - Phone:410-324-2400
Mailing Address - Fax:
Practice Address - Street 1:1400 FRONT AVE STE 303
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5364
Practice Address - Country:US
Practice Address - Phone:410-324-2400
Practice Address - Fax:410-324-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251X00000X
MD30AL111310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD159200900Medicaid
MD47103452700Medicaid
MD159200900Medicaid